celebrity!chefs!

MSc$in$Public$Health$and$Health$Services$Research:$Dissertation$$ $ $ $

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Quick,$easy…$and$nutritious?$ How$healthy$are$meals$in$celebrity$chefs’$recipe$ books$and$standard$supermarket$ready$meals?$ $ $ $ $ $ $ $ $ ! Simon!Howard! Supervised$by$Jean$Adams$and$Martin$White!

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MSc,!Postgraduate!Diploma!and!Postgraduate!! Certificate!in!Public!Health!&!Health!Services!Research! Assignment!declaration!form$ $ Module:$$

Dissertation$

Student$number$(9$digit$number):$$

030022988$

Assignment$due$date:$$

31st0August020110

Word$Count$(excluding$figures$and$tables):$

0

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Main0Thesis0

14,9980(Max015,000)0

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Project0Management0Appendix0

1,9950(Max02,000)0

Extension$date$(if$previously$agreed):$$

Not0applicable$

Date:$$

30th0August02011$

$ 0 I0declare0that0this0assignment0is0my0own0work0and0that0I0have0correctly0acknowledged0 the0work0of0others.0 This0is0in0accordance0with0University0guidance0on0good0academic0conduct0(and0how0to0 avoid0plagiarism0and0other0assessment0irregularities).0 University0guidance0is0available0at:0www.ncl.ac.uk/rightPcite$

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Table!of!contents! ! List$of$tables$and$figures ................................................................................................................................................ 5$ List$of$abbreviations ........................................................................................................................................................ 6$ Summary............................................................................................................................................................................... 7$ Background.......................................................................................................................................................................... 9$ Literature$review ........................................................................................................................................................... 11$ Evidence0of0the0influence0of0celebrity0chefs ................................................................................................. 11$ Evidence0of0the0influence0of0ready0meals ...................................................................................................... 21$ Relevant0government0policy0on0food0and0nutrition ................................................................................. 24$ Comparisons0of0ready0meals0and0celebrity0recipes .................................................................................. 29$ Aim$&$Objectives ............................................................................................................................................................ 30$ Methodological$considerations................................................................................................................................ 31$ Selection0of0comparable0samples ..................................................................................................................... 31$ Selection0of0ready0meal0sampling0frame....................................................................................................... 32$ Data0collection0methods0for0prepared0meals0group ................................................................................ 35$ Selection0of0celebrity0recipe0sampling0frame .............................................................................................. 36$ Data0collection0methods0for0celebrity0meals0group ................................................................................. 37$ Methods.............................................................................................................................................................................. 39$ Data0collection0methods....................................................................................................................................... 39$ Analytical0methods ................................................................................................................................................. 42$ Ethics0and0funding .................................................................................................................................................. 44$ Results................................................................................................................................................................................. 45$ Summary0of0data0collected ................................................................................................................................. 45$ Analytical0results..................................................................................................................................................... 47$ Discussion ......................................................................................................................................................................... 57$ Statement0of0principal0findings......................................................................................................................... 57$ Strengths0of0study ................................................................................................................................................... 57$ Limitations0of0study................................................................................................................................................ 59$ Comparison0with0other0literature.................................................................................................................... 64$ Unanswered0questions0and0future0research ................................................................................................ 65$ Meaning0of0the0study0and0implications.......................................................................................................... 66$ References......................................................................................................................................................................... 69$ Appendix$1:$Project$Management........................................................................................................................... 81$ Developing0initial0project0plan.......................................................................................................................... 81$

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Project0plan0revision .............................................................................................................................................. 81$ Financial0Management......................................................................................................................................... 82$ Quality0control.......................................................................................................................................................... 82$ Handling0risk............................................................................................................................................................. 83$ Time0management0and0milestones.................................................................................................................. 84$ Corrective0action ..................................................................................................................................................... 84$ Lessons0learned0about0project0management .............................................................................................. 85$ Lessons0learned0about0scientific0enquiry ...................................................................................................... 86$ Appendix$2:$Original$Protocol .................................................................................................................................. 88$ Background................................................................................................................................................................ 89$ Background0Literature ......................................................................................................................................... 91$ Aim0of0Project............................................................................................................................................................ 92$ Methods ....................................................................................................................................................................... 93$ Costs,0Feasibility0and0Timings............................................................................................................................ 98$ Ethical0and0Governance0Issues .......................................................................................................................... 98$ Risk0Management.................................................................................................................................................... 98$ Table01:0Eligible0Books........................................................................................................................................100$ Figure01:0Gantt0Chart...........................................................................................................................................106$ References.................................................................................................................................................................107$

Quick,$Easy,$and$Nutritious?$ $

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List!of!tables!and!figures! Table$1:$Confidence$in$ability$to$cook$from$basic$ingredients$(based$on$Table$14$in$Lang$and$ Caraher,$19991)............................................................................................................................................................... 25$ Table$2:$Recipes$considered,$eligible,$and$included$by$recipe$book........................................................ 45$ Table$3:$Products$considered,$eligible,$and$included$by$supermarket................................................... 46$ Table$4:$Fruit,$vegetable$and$nut$content$as$a$proportion$of$product$weight..................................... 47$ Table$5:$Comparison$of$proportion$of$sample$classified$as$HFSS............................................................. 48$ Table$6:$Median$figures$for$nutritional$data$per$100g .................................................................................. 49$ Table$7:$Percentage$energy$from$macronutrients,$and$fibre$and$sodium$density ............................ 50$ Table$8:$Proportion$of$meals$meeting$WHO$energy$goals$for$each$macronutrient.......................... 51$ Table$9:$Median$figures$for$nutritional$data$per$portion ............................................................................. 52$ Table$10:$Kruskal`Wallis$testing$for$differences$between$recipe$books$and$between$ supermarkets$in$per`portion$values...................................................................................................................... 54$ Table$11:$Modal$traffic$light$colour$for$each$macronutrient$by$group ................................................... 56$ $ Figure$1:$Median$nutritional$data$for$each$group$as$a$percentage$of$the$Guideline$Daily$ Amount$recommended$by$COMA............................................................................................................................ 53$ Figure$2:$Number$of$'traffic$lights'$of$each$colour$in$each$group.............................................................. 55$ $

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List!of!abbreviations!! COMA!

UK$Committee$on$Medical$Aspects$of$Food$and$Nutrition$Policy$

FFQ!

Food$frequency$questionnaire$

FSA!

Food$Standards$Agency$

GDA!

Guidelines$daily$amount$

HFSS!

High$in$fat,$salt,$or$sugar$

HLS!

Health$and$Lifestyles$Survey1$

LIDNS!

Low$Income$Diet$and$Nutrition$Survey2$

NHS$

National$Health$Service$

PFQ!

Personal$factors$questionnaire$

RDA!

Recommended$daily$allowance$

WHO!

World$Health$Organisation$

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Summary! Aim$

This$study$aimed$to$compare$the$nutritional$content$of$main$course$ recipes$featured$in$celebrity$chefs’$recipe$books$and$that$of$standard$ ready$meals$sold$in$the$three$largest$UK$supermarket$chains$with$WHO$ and$FSA$nutritional$standards.$

Design$

The$study$compared$calculated$nutritional$data$based$on$the$raw$ ingredients$of$celebrity$chefs’$recipes$and$manufacturers’$data$on$the$ nutritional$content$of$ready$meals$with$nutritional$standards$set$by$the$ WHO$and$FSA.$Comparisons$were$also$made$between$the$two$groups.$

Samples$

The$recipe$sample$consisted$of$100$main$course$recipes$selected$at$ random$from$five$best`selling$celebrity$chefs’$cookbooks,$in$proportion$ to$the$total$number$included$in$each$book.$The$ready$meal$sample$ consisted$of$100$standard`range$ready$meals$selected$at$random$from$ three$supermarkets,$in$proportion$to$the$total$number$offered$by$each$ supermarket.$

Measures$

Comparison$of$proportions$of$energy$derived$from$each$macronutrient$ with$WHO$standards;$FSA$‘traffic`light’$style$labelling$analyses$for$each$ group;$comparison$with$FSA$criteria$for$foods$high$in$fat,$sugar$or$salt;$ comparison$of$nutrient$data$per$100g$of$meal;$and$comparison$of$ nutrient$data$per$portion$of$meal.$

Results$

There$was$little$absolute$difference$in$nutritional$content$between$the$ groups.$Few$meals$in$either$group$were$compliant$with$WHO$ recommendations$on$energy$derivation,$though$significantly$fewer$ celebrity$meals$complied.$Celebrity$meals$scored$more$‘red$traffic$lights’$ by$the$FSA’s$food$labelling$recommendations$than$the$ready$meal$group.$ The$celebrity$recipes$had$a$significantly$higher$median$for$calorific$ content,$fat$and$saturated$fat$per$portion,$but$significantly$lower$median$

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fibre$content$than$ready$meals.$More$celebrity$recipes$than$ready$meals$ had$high$proportions$of$fruit,$vegetable,$and$nut$content.$$ Conclusions$ Ready$meals$may$be$less$“unhealthy”$than$is$commonly$assumed.$Home$ cooking$is$not$necessarily$“healthier”$than$consumption$of$ready$meals.$ Government$policy$advocates$teaching$of$cooking$skills$in$order$to$ reduce$ready`meal$consumption.$This$appears$to$be$predicated$on$the$ assumption$that$ready$meals$are$“unhealthy”$while$home`cooked$food$is$ “healthy”.$This$study$challenges$that$assumption,$and$the$policy$may$ need$to$change$if$it$is$to$be$effective$in$improving$the$health$of$the$ nation.$

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Background! British$television$cookery$programmes$presented$by$celebrity$chefs$draw$several$ million$viewers,$and$frequently$appear$in$each$week’s$top$thirty$viewed$programmes$ in$the$UK.3$In$December$2010,$the$BBC$showed$new$episodes$in$four$such$series$in$ one$week:$Nigella0Kitchen,$The0Hairy0Biker’s0Cook0Off,$Nigel0Slater’s0Simple0Suppers,$and$ Rick0Stein’s0Cornish0Christmas.4$A$dedicated$UK$channel,$Good0Food5,$regularly$ broadcasts$ten$hours$of$such$programming$per$day.6$$ In$December$2010,$the$tieìn$book$to$chef$Jamie$Oliver’s$television$series,$Jamie’s0300 Minute0Meals,$became$the$UK’s$fastest$selling$non`fiction$book$of$all$time.7$The$UK’s$ all`time$best`selling$cookbook$is$by$a$television$chef:$Delia0Smith’s0How0to0Cook0(Book0 One).7$In$addition,$celebrity$chefs$appear$and$demonstrate$recipes$on$other$ programmes$such$as$ITV’s$This0Morning,8$and$the$BBC’s$Saturday0Kitchen.9$Hence,$ celebrity$chefs$appear$popular$in$the$UK.$ The$Department$of$Health,$via$its$Change4Life$initiative,$aims$to$provide$individuals$ with$the$“knowledge,$skills$and$confidence$to$cook$from$scratch”,$and$reduce$“reliance$ on$convenience$food”.10$The$belief$that$home$cooking$can$lead$to$improved$nutrition$ and$reduce$prevalence$of$obesity$is$also$evident$in$the$cross`government$strategy$ document$Healthy0Weight,0Healthy0Lives.11$This$states$that$cooking$classes$“give$all$ young$people$the$understanding$and$skills$to$eat$more$healthily”$(page$vii).11$The$ current$Government$remains$under$pressure$to$expand$the$programme$of$teaching$ cookery$skills$in$schools,12$and$has$committed$to$continuing$the$Change4Life0 initiaive.13$$ A$common$alternative$to$home$cooking$is$the$pre`prepared$“ready$meal”$(known$as$ “TV$dinners”$in$the$US14).$These$are$main$courses,$which$come$pre`prepared$in$a$ single$package$with$only$minimal$preparation$required$prior$to$consumption.15$$ Ready$meals$often$attract$criticism.$NHS$advice$on$dietary$balance$suggests$that$they$ are$“OK$occasionally$[but]$many$contain$high$levels$of$fat,$added$sugar$and$salt.$If$you$ eat$ready$meals$too$often,$they'll$upset$the$balance$in$your$diet”.16$Other$NHS$advice$

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suggests$that$“even$'healthier'$ready$meals$will$probably$be$higher$in$fat$and$calories$ than$the$homemade$equivalent”.17$$ In$2003,$a$Food$Standards$Agency$investigation$found$that$83%$of$ready$meals$ contained$over$40%$of$the$recommended$daily$allowance$of$salt.18$More$recent$data$ suggests$that$salt$content$remains$higher$than$would$be$desirable.19$Concern$has$also$ been$expressed$about$the$fat$content20$and$calorific$density21$of$such$meals.$However,$ the$industry$appears$to$have$responded$to$these$concerns,$with$a$number$of$ reformulation$initiatives.22`28$ In$the$content$of$governmental$advice$suggesting$that$“home`cooked$foods”$are$ healthy$and$“ready$meals”$are$unhealthy,16,17$individuals$who$rely$on$ready$meals$may$ feel$encouraged$to$try$home$cooking.$Whilst$celebrity$chefs’$recipes$may$not$be$ representative$of$all$home`cooked$meals,$their$popularity$may$make$them$the$ alternative$towards$which$individuals$unfamiliar$with$home$cooking$gravitate$for$ ideas$and$advice.$Yet$there$is$nothing$in$the$research$literature$about$the$nutritional$ content$of$these$chefs’$recipes.$ This$project$intends$to$fill$this$research$gap$by$identifying$whether$“ready$meals”$or$ “celebrity$recipes”$can$be$considered$healthy.$

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Literature!review! This$review$discusses$literature$about$ready$meals$and$celebrity$recipes,$including$ both$the$nutritional$content$of$the$food,$and$wider$issues$surrounding$celebrity$ recipes$and$ready$meals.$ Initial$scoping$searches$were$conducted$through$Google$Scholar,$using$combinations$ of$the$search$terms$“UK$Government”,$“ready$meal”,$“convenience$food”,$“TV$dinners”,$ “celebrity$chef”,$“popular$recipes”$and$“television$cooking”.$The$titles$of$identified$ studies$were$screened$for$relevance,$followed$by$the$abstracts.$The$same$terms$were$ used$on$Google’s$web$search$engine,$with$and$without$restriction$to$UK$websites.$ Relevant$papers$found$via$the$scoping$searches$were$included$in$the$literature$review.$ The$references$from$these$papers$were$screened$by$for$relevance$by$title,$abstract,$ and$content$of$the$paper.$Further$literature$was$harvested$from$searches$of$Medline’s$ indexed$citations,$Embase,$and$Books@Ovid,$using$combinations$of$the$same$search$ terms,$and$the$same$screening$procedure.$ Government$policy$papers$were$located$through$personal$knowledge$of$documents,$ and$the$scoping$searches.$Further$white$and$grey$literature$was$identified$following$ discussion$with$project$supervisors$and$food$and$nutrition$specialists$within$the$ Institute$of$Healthy$&$Society.$ As$a$monoglot,$I$pragmatically$limited$inclusion$to$those$papers$published$in$English.$ This$is$unlikely$to$cause$serious$bias$as$the$majority$of$papers$about$British$society$ are$likely$published$in$English.$ This$review$has$three$sections:$the$first$two$discuss$evidence$about$celebrity$chefs$ and$ready$meals$respectively,$while$the$third$discusses$national$food$and$nutrition$ policies.$

Evidence!of!the!influence!of!celebrity!chefs! This$section$discusses$the$influence$that$“celebrity$chefs”$exert$over$the$nutritional$ intake$of$the$British$population.$Some$individuals$eschew$the$epithet$“celebrity$chef”:$ MSc$Dissertation$

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Delia$Smith$protested,$“I$am$not$a$chef”,29$and$Nigella$Lawson$introduced$How0to0Eat$ with$an$assertion$that$“I$am$not$a$chef.$I$am$not$even$a$trained$or$professional$cook”.30$ Use$of$the$term$“celebrity$chef”$in$this$review$refers$to$individuals$who$demonstrate$ recipes$and$cooking$techniques$on$television$programmes$in$the$UK.$It$is$not$intended$ to$imply$any$formal$qualification$or$training.$$ The$influence$of$television$programmes$on$cooking$attitudes$and$behaviours$ There$is$no$clear$consensus$in$the$literature$on$the$type$or$degree$of$influence$ television$cookery$programmes$exert$on$viewers.$ Clifford$(2009)$conducted$a$US$study$regarding$the$influence$of$television$ programmes$on$student’s$cooking$behaviour.31$101$students$studying$higher`level$ courses$unrelated$to$health$or$nutrition$were$recruited,$52%$of$whom$reported$ cooking$dinner$at$least$four$times$per$week$prior$to$the$study.$Academic$credit$was$ used$to$incentivise$participation.$ The$50$individuals$in$the$intervention$group$were$shown$four$15`minute$episodes$of$a$ specially$made$television$series$–$Good0Grubbin’$–$over$the$course$of$four$weeks.$The$ control$group$did$not$see$the$programme.$$ Each$episode$of$Good0Grubbin’$consisted$of$a$student$describing$a$nutritional$challenge$ to$a$dietician,$such$as$weight$loss$or$cooking$for$friends.$The$dietician$provided$advice$ on$products$to$buy,$and$demonstrated$recipes$using$the$purchased$food.$$ The$participants$completed$two$surveys$at$preìntervention,$postìntervention,$and$ four`month$followùp$stages:$a$food`frequency$questionnaire$(FFQ)$and$a$personal$ factors$questionnaire$(PFQ).$The$FFQ$asked$participants$to$rate$the$frequency$with$ which$they$ate$listed$products.$The$PFQ$tested$knowledge$of$nutritional$ recommendations$such$as$frequency$of$fruit$and$vegetable$consumption,$and$asked$ participants$to$rate$agreement$with$statements$such$as$“I$can$cook$a$nutritious$meal”.$ The$intervention$group$scored$significantly$higher$on$knowledge$questions$post` intervention,$and$also$reported$greater$motivation$to$cook.$The$changes$persisted$to$ four`month$followùp,$and$contrast$with$the$control$group$where$no$significant$

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changes$were$observed.$However,$no$significant$changes$were$found$in$reported$ behaviour$in$either$group$as$a$whole.$The$study$concluded,$“given$limited$resources,$a$ cooking$and$nutrition$programme$may$be$a$reasonable$and$costèffective$way$to$ reach$large$audiences”.$$ This$study$had$a$number$of$strengths:$the$inclusion$of$a$control$group$allowed$ causality$to$be$inferred$with$greater$certainty,$and$the$four`month$followùp$allowed$ assessment$of$whether$changes$are$transient$or$lasting.$Yet$the$conclusions$drawn$ appear$to$extend$beyond$the$support$of$the$data.$ Only$59%$of$students$participated$in$the$four`month$followùp.$This$did$not$affect$ either$group$disproportionately,$and$the$preìntervention$responses$of$the$dropouts$ did$not$significantly$differ$from$the$whole`study$participants.$Yet$it$seems$likely$that$ those$participants$who$continued$with$the$study$would$be$those$with$an$interest$in$ the$topic.$Given$that$this$study$attempts$to$assess$knowledge$and$attitudes,$this$ represents$a$significant$threat$to$the$external$validity$of$the$findings.$ There$is$also$serious$methodological$misrepresentation$within$this$study.$The$results$ are$presented$as$being$reflective$of$a$televisual$intervention,$yet$the$programmes$ were$delivered$online.$The$conditions$under$which$individuals$view$a$programme$ online$likely$differ$from$those$in$which$they$would$typically$watch$television.$ Concentration$on$an$online$narrowcast$may$be$higher$than$that$on$broadcast$ television,$particularly$when$viewing$is$being$incentivised$as$in$this$study.$Their$ conclusion,$therefore,$that$television$programmes$represent$a$costèffective$ educational$solution$is$unsupported$by$their$data.$ The$generalisability$of$this$study$is$threatened$by$manipulation$of$the$script$of$the$ programmes$to$include$specific$nutritional$facts.$For$example,$the$“MyPyramid$fruit$ and$vegetable$recommendation”$was$incorporated$into$the$script$of$each$episode$of$ the$programme.$Given$the$degree$of$repetition$over$the$course$of$the$series,$it$is$ unsurprising$that$participants$were$able$to$give$correct$answers$to$factual$questions$ postìntervention.$Such$nutritional$messages$are$not$incorporated$into$most$British$ television$cookery$programmes,$and$hence$the$study$cannot$be$considered$as$ generalisable$to$the$UK$television$landscape.$ MSc$Dissertation$

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Similarly,$a$major$point$of$difference$between$the$programme$in$this$study$and$the$ most$popular$cookery$programmes$in$the$UK$is$the$lack$of$inclusion$of$a$“celebrity$ chef”.$The$literature$suggests$that$celebrity$endorsement$of$products$can$increase$the$ likelihood$of$effecting$behaviour$change.32$A$similar$argument$may$apply$to$celebrity$ chefs’$television$programming:$the$presence$of$a$celebrity$may$increase$the$likelihood$ of$behaviour$change$in$the$viewer.$ Most$importantly,$no$significant$behaviour$change$was$detected,$despite$reported$ efforts$to$change$behaviour.$FFQs$are$poor$at$picking$up$subtle$dietary$changes,33$as$ might$be$expected$in$this$study,$yet$still$this$study$found$no$evidence$of$a$significant$ change$in$consumption$of$food$items.$It$therefore$seems$unreasonable$to$conclude$ that$this$intervention$is$“reasonable”$or$“costèffective”$in$changing$nutritional$habits,$ even$if$it$does$have$an$effect$on$their$knowledge.$ Jenkins$(1975)$conducted$a$similar$pre`$and$postìntervention$questionnaire$study$of$ the$effectiveness$of$a$television$programme$–$Mulligan0Stew$–$in$changing$the$ nutritional$attitudes$and$behaviours$of$Michigan$children.34$This$study$also$found$ increased$knowledge$amongst$participants$after$the$intervention,$but$no$significant$ dietary$change.$However,$the$participants$were$aged$just$ten$and$eleven$years,$and$ hence$their$ability$to$effect$change$in$their$dietary$behaviour$was$likely$limited$by$ parental$control.$ Both$of$these$studies$are$in$keeping$with$the$principle$that$education$alone$rarely$ affects$health`related$behaviour.35$Yet,$this$is$challenged$by$UK$market$data.$Sales$of$ many$ingredients$have$increased$notably$after$featuring$on$celebrity$chefs’$television$ programmes.36`40$Whilst$it$cannot$be$concluded$with$certainty$that$these$ingredients$ are$actually$used,$this$does$provide$evidence$of$programmes$influencing$behaviour.$ Foster$(2009)$examined$UK$market$data$as$part$of$a$briefing$on$the$health$benefits$of$ culinary$oils.41$He$reported$a$marked$increase$in$the$sales$of$specialty$oils,$such$as$ coconut$and$olive$oil,$between$1990$and$2003.$Foster$suggests$that$“cookery$ programmes$on$television$and$the$celebrity$status$of$chefs$have$made$consumers$ more$interested$…$in$the$quality$and$variety$of$ingredients$they$use”,41$though$no$data$ is$given$to$support$this$assertion.$$ MSc$Dissertation$

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There$are$many$alternative$explanations$for$this$trend.$Immigration$has$increased$ over$the$same$period,42$and$hence$these$figures$may$represent$imported$cooking$ practices.$The$average$number$of$lines$carried$by$UK$supermarkets$has$increased$ over$the$same$period,43$and$hence$exotic$oils$may$be$more$readily$available$to$ consumers$(though$the$retail$prices$of$oil$have$increased$faster$than$the$general$Food$ Prices$Index41).$Alternatively,$individuals$may$be$changing$their$nutritional$behaviour,$ but$television$programmes$and$celebrity$chefs$may$not$be$causing$this.$Or,$as$ discussed$above,$individuals$may$be$motivated$to$buy$exotic$oils,$but$rarely$use$them.$ Without$further$data,$it$is$impossible$to$conclude$–$as$Foster$has$done41$–$that$this$ change$in$buying$habits$either$represents$a$change$in$dietary$habit$or$is$due$to$ celebrity$chefs.$ In$summary,$the$literature$suggests$that$television$programmes$have$some$influence$ on$the$attitudes$of$viewers$towards$food$and$cooking.$There$is$an$absence$of$good$ academic$evidence$of$a$change$in$behaviour,$but$equally$there$is$no$good$academic$ evidence$of$no$change$in$behaviour.$The$influence$of$television$programmes$on$ nutritional$behaviour$remains$unclear.$ The$extent$to$which$celebrity$chefs$are$sources$of$cooking$knowledge$and$skill$ Caraher$(2002)$analysed$quantitative$data$from$the$UK$national$Health$and$Lifestyles$ Survey$(HLS)$and$qualitative$data$from$focus$groups$held$in$London.44$$ The$1993$HLS$interviewed$5,553$adults$from$a$random$sample$of$addresses$across$ England,$stratified$by$NHS$region.$Statistical$adjustments$were$used$to$increase$the$ generalisability$of$the$results.1$ Of$relevance$to$this$review,$participants$were$asked$to$cite$sources$from$which$they$ learned$more$about$cooking$during$adulthood.$Participants$most$commonly$cited$ cookbooks$(43%),$though$a$minority$cited$television$programmes$(19%).$These$were$ cited$more$commonly$by$women$(24%)$than$men$(15%).44$There$was$no$attempt$to$ control$for$social$desirability$response$bias45$in$this$study,$which$may$have$lead$to$ over$citation$of$books$and$under$citation$of$television$programmes.$Hence,$the$true$ proportion$of$participants$influenced$by$television$programmes$may$be$higher$still.$

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From$the$focus$groups,$Caraher$reports$“an$almost$universal$feeling$that$cooking$ programmes$were$not$about$learning$cooking$skills$…$Respondents$saw$them$as$ offering$entertainment”.44$Yet,$the$degree$to$which$the$focus$group$findings$can$ explain$the$HLS$is$limited.$The$HLS$was$conducted$in$1993,$when$four$channels$ accounted$for$72.2%$of$British$television$viewing.46$The$focus$groups$were$conducted$ in$1999,$when$the$same$four$channels$accounted$for$just$61.6%$of$viewing.46$The$ television$landscape$had$transformed$over$this$period,$and$hence$the$attitude$of$focus$ group$participants$towards$programming$may$differ$substantially$from$that$of$ participants$in$the$HLS.$ A$shift$towards$cookery$programmes$being$viewed$as$‘entertainment’$may$represent$ an$underlying$change$in$the$tone,$style,$and$content$of$the$programmes.$Perhaps$ programmes$have$become$more$focussed$on$entertainment$than$education$in$an$ attempt$to$win$viewers$in$a$more$competitive$environment.$It$is$certainly$true,$for$ example,$that$the$content$is$more$varied,$soundtracks$more$prominent,$and$locations$ more$lavishly$decorated$in$Nigella0Bites,$filmed$in$the$early$2000s,$as$compared$with$ Craddock0Cooks0for0Christmas,$filmed$in$the$mid`1970s.$The$pace$of$this$change$may$ have$been$such$that$the$perception$of$the$genre$changed$markedly$over$the$six$ intervening$years$in$this$study.$ From$the$qualitative$and$quantitative$findings,$Caraher$suggests$not$only$that$TV$ programmes$may$not$be$appropriate$places$to$include$health$promotion$messages,$ but$that$“attacking$such$programmes$for$not$including$education$may$be$tilting$at$ windmills”.44$This$conclusion$appears$at$odds$with$the$quantitative$data,$which$ suggests$that$almost$a$quarter$of$female$participants$cited$television$programmes$as$a$ source$of$cooking$knowledge$and$skills.$In$this$context,$it$is$difficult$to$see$how$ inclusion$of$health$education$messages$is$inappropriate,$even$if$focus$groups$suggest$ that$this$content$is$not$expected.$ The$HLS$findings$contrast$with$those$of$the$2007$Low$Income$Diet$and$Nutrition$ Survey$(LIDNS).2$This$sampled$25,818$addresses$across$the$UK$selected$to$be$ representative$of$the$most$deprived$15%$of$British$households.$In$this$study,$only$4%$

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of$participants$cited$television$as$sources$of$cooking$knowledge,$split$evenly$by$ gender.2$ This$may$appear$to$represent$a$substantial$difference$between$the$sources$of$ knowledge$in$low$income$groups$and$the$general$population:$yet$the$data$is$not$ comparable.$The$HLS$question$referred$specifically$to$sources$of$cooking$skill$“later$ on”$in$life,1$while$the$LIDNS$asked$where$participants$“learned$to$cook”.2$It$seems$ likely$that$LIDNS$responses$will$concentrate$on$how$participants$first$learned$to$cook,$ and$hence$gives$little$insight$into$how$adults$refine$and$expand$their$cooking$skills.$ Reilly$(2006)$conducted$a$series$of$UK$focus$groups$between$1992$and$1998$that$ collected$qualitative$data$on$the$influence$of$the$media$on$food$choices.47$This$ focussed$primarily$on$news$coverage$of$food`related$stories,$but$some$parts$of$the$ research$discussed$the$impact$of$celebrity$chefs’$television$programmes.$ In$1989,$there$was$a$widespread$outbreak$of$salmonella$in$the$UK,$attributed$to$ contaminated$eggs.$As$part$of$Reilly’s$focus$groups,$participants$were$asked$to$cite$ trusted$sources$of$information$about$the$outbreak,$and$to$describe$the$factors$that$ influenced$them$in$deciding$whether$eggs$were$safe$to$eat.$Two$of$the$most$frequently$ cited$sources$were$Delia$Smith$and$the$television$programme$Ready,0Steady,0Cook.47$ Group$reinforcement$may$mean$that$the$influence$of$these$sources$was$overstated$in$ the$focus$group$environment,$making$the$apparent$position$more$extreme$than$the$ true$position.48$However,$Reilly$reports$that$they$were$“referenced$extensively”,47$ implying$that$they$were$independently$suggested$at$several$focus$groups.$This$lends$ weight$to$the$suggestion$that$celebrity$chefs$and$television$programmes$influenced$ individuals’$opinions$in$this$case.$$ In$summary,$television$programmes$are,$by$common$consent,$sources$of$cooking$ knowledge$and$skill.$However,$the$degree$to$which$this$is$the$case$remains$unclear.$

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The$influence$of$television$programmes$on$children’s$nutritional$attitudes$and$ behaviours$ The$breadth$and$reach$of$the$televisual$medium$is$such$that$children$are$likely$to$ watch$celebrity$chefs’$programming,$yet$its$effect$on$children$appears$to$have$been$ little$studied.$A$number$of$papers$contribute$to$wider$understanding$of$these$issues.$ Dammann$(2010)$conducted$fourteen$focus$groups$with$92$lowìncome$Minnesotan$ children,$aged$9`13$years.49$Over$half$of$the$children$were$overweight$or$obese,$half$ were$African$American,$and$two`thirds$had$annual$household$incomes$of$less$than$ $10,000.$Participation$was$incentivised$by$a$cash$payment.49$ When$the$acquisition$of$cooking$skills$was$discussed,$participants$cited$relatives,$ experimentation,$and$television$cookery$programmes$as$the$sources$of$their$cooking$ skill.49$The$study$design$is$not$appropriate$for$assessing$the$validity$of$their$claims,$ and$it$does$not$attempt$to$do$so.$Participants$may$think$that$they$are$able$to$perform$ skills$they$have$seen$on$television,$but$have$never$attempted.$$ Yet,$spontaneous$citation$of$television$programmes$as$a$source$of$cookery$skill$ suggests$that$children$are$aware$of$such$programmes,$and$may$find$them$of$ educational$value.$Of$the$three$sources$cited$by$the$children,$television$programmes$ are$the$most$obviously$externally$modifiable.$Imbuing$these$programmes$with$ positive$health$messages$may$transform$children’s$nutritional$landscapes.$ Byrd`Bredbenner$(2010)$conducted$a$study$of$the$influence$of$non`cookery$television$ programmes$on$children.50$Seventyòne$New$Jersey$girls$aged$9$and$10$years$were$ randomised$to$viewing$or$not$viewing$an$episode$of$The0Simpsons.$Both$groups$ completed$a$questionnaire$testing$both$knowledge$and$attitudes$preìntervention,$one$ to$two$weeks$postìntervention,$and$at$followùp,$a$further$one$to$two$weeks$later.50$$ The$episode$featured$Lisa,$an$eight`yearòld$female$character,$becoming$vegetarian.$ After$several$attempts$to$impose$her$views$on$others,$she$is$convinced$by$Paul$and$ Linda$McCartney$to$practice$vegetarianism$whilst$being$tolerant$of$others’$views.$The$ episode$was$shown$to$participants$without$advertisements.50$

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The$pre`test$scores$were$comparable$for$both$groups.$At$the$post`test$stage,$ understanding$of$vegetarianism$was$significantly$higher$in$the$intervention$group,$ persisting$to$followùp.$The$intervention$group$showed$significantly$greater$ disagreement$with$the$statement$“There’s$nothing$wrong$with$eating$meat”$at$the$ post`test$stage,$and$rated$themselves$significantly$more$likely$to$become$vegetarian.$ The$difference$in$these$attitudes$did$not$persist$to$followùp.50$ The$study$did$not$examine$the$actual$behaviours$of$the$participants,$and$the$study$is$ limited$by$a$small,$narrowly$selected$sample.$Yet$the$finding$that$knowledge$increased$ and$attitudes$changed$(albeit$transitorily)$on$viewing$a$programme$that$is$not$ explicitly$designed$to$educate$about$food$demonstrates$the$degree$of$influence$of$ television$on$children.$ The$BBC$offers$a$celebrity$chef$style$programme$targeted$at$children.51$Big0Cook0Little0 Cook,$featuring$the$fictional$chefs$Ben$and$Small,$is$broadcast$several$times$daily$on$ CBeebies,51$the$BBC’s$channel$for$young$children.52$Despite$Small$being$only$a$foot$tall$ and$riding$on$a$flying$wooden$spoon,53$the$programme$has$much$in$common$with$ celebrity$chefs’$programming$for$adults.$Each$episode$features$demonstration$of$a$ recipe$and$discussion$of$healthy$eating.51$The$programme$is$expressly$constructed$“to$ promote$healthy$eating$and$inventive$cooking$to$young$children”.51$ There$is$no$academic$literature$assessing$the$effectiveness$of$Big0Cook0Little0Cook,$yet$ the$fact$that$it$has$run$continuously$for$eight$years$to$date54$suggests$that$it$is$highly$ regarded$by$some$–$perhaps,$in$particular,$its$target$audience.$Of$course,$popularity$ does$not$equate$to$effectiveness.$ In$summary,$whilst$some$children$cite$television$programmes$as$a$source$of$cookery$ knowledge$and$skill,$a$paucity$of$literature$makes$it$difficult$to$assess$to$their$true$ impact.$$ Sphere$of$influence$occupied$by$celebrity$chefs$ Celebrity$chefs’$activities$and$influence$often$extend$far$beyond$presentation$of$ television$programmes:$they$are$multimedia$personalities.$Jamie$Oliver’s$influence$ extends$to:$twelve$recipe$books55;$a$magazine56;$a$website57;$several$mobile$phone$ MSc$Dissertation$

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applications58;$a$video$game59;$three$restaurant$chains60`62;$cooking$ingredients$and$ equipment63;$Sainsbury’s$advertisments64;$political$lobbying65;$a$charitable$ foundation66;$social$media67,68;$and$a$range$of$gardening$products69.$This$is$in$addition$ to$eighteen$UK$television$series70$and$appearances$on$other$programmes.$ Whilst$Jamie$Oliver$is$atypically$prolific,$most$celebrity$chefs$have$a$wider$sphere$of$ influence$than$their$television$programmes$alone.$Indeed,$it$is$likely$that$many$people$ are$exposed$to$their$recipes$without$ever$having$watched$their$programmes.$$ In$the$1993$Health$and$Lifestyle$Survey,44$discussed$earlier,$participants$cited$ “cookbooks”$as$a$common$source$of$cooking$knowledge.$Many$of$these$cookbooks$are$ within$the$sphere$of$influence$of$celebrity$chefs:$indeed,$the$best`selling$and$fastest` selling$cookbooks$in$the$UK’s$history$are$companion$volumes$to$television$series.7$$ The$nutritional$messages$proliferated$by$celebrity$chefs$are$likely$to$have$a$wider$ impact$than$influencing$just$those$who$watch$their$television$programmes,$and$their$ influence$is$so$wide$that$its$full$extent$may$be$difficult$to$appreciate.$ Evidence$regarding$the$nutritional$content$of$celebrity$recipes$ No$academic$literature$discussing$the$nutritional$value$of$the$recipes$promoted$by$ celebrity$chefs$could$be$located$for$this$review.$ The$linguistic$and$pictorial$imagery$used$in$celebrity$chefs’$cookbooks$is$often$ suggestive$of$health:$the$cover$of$Jamie$Oliver’s$Ministry0of0Food0states,$“cooking$good$ food$from$scratch$…$can$put$you,$your$family$and$your$friends$on$a$track$to$a$healthier$ life”.71$Similarly,$Hugh`Fearnley$Whittingstall$describes$his$recipes$as$“wholesome”,72$ Gino$D’Acampo$claims$his$recipes$have$“many$health$benefits”,73$and$“super`fit$chef”74$ Gordon$Ramsay’s$cookbook$claims$to$offer$recipes$“packed$with$fresh,$vital$ ingredients$cooked$in$the$most$healthy$way”.74$ Additionally,$there$is$a$media$perception$that$home$cooking$is$healthier,75`77$and$the$ government’s$Change4Life$initiative10,11$also$seems$to$be$predicated$on$this$ assumption,$as$discussed$earlier.$Following$a$celebrity$recipe$is$an$example$of$home$ cooking$(though$many$other$forms$of$home$cooking$also$exist).$Despite$this,$celebrity$

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chefs$are$often$criticised$for$promoting$unhealthy$recipes,78`80$and$some$recipe$books,$ such$as$two$recent$publications$that$give$“takeaway`style”$recipes,$appear$to$actively$ promote$unhealthy$home$cooking.81,82$ This$confusion$regarding$the$nutritional$value$of$the$meals$promoted$by$celebrity$ chefs$has$not$resulted$in$any$published$academic$study$examining$the$nutritional$ content$of$the$meals.$Yet,$the$studies$discussed$earlier$show$that$both$television$ programmes$and$cookbooks$are$important$sources$of$cookery$knowledge$and$skills$ for$the$population.$Hence,$there$is$a$significant$knowledge$gap,$which$makes$ assessment$of$the$governmental$drive$towards$home$cooking$difficult.$

Evidence!of!the!influence!of!ready!meals! Use$of$the$term$“ready$meal”$varies$between$different$sources.$The$industry$includes$ two$broad$types$of$products$in$its$definition.$Firstly,$“composite$meals”,$which$come$ pre`cooked$in$a$single$package$with$no$further$ingredients$and$little$preparation$ required$prior$to$consumption.$Secondly,$“meal$centres”,$which$are$pre`cooked$ products,$to$which$“vegetables,$pasta$or$rice”$might$typically$be$added.15$Academic$ studies$often$examine$“convenience$foods”,$a$term$which$covers$a$selection$of$ products$that$is$wider$still.$ Hence,$some$products$often$cited$as$“ready$meals”$would$seldom$be$eaten$without$ accompaniment.$These$may$not$be$considered$“meals”$in$the$everyday$sense$of$the$ word.$The$problem$of$defining$a$“ready$meal”$will$be$discussed$in$more$detail$in$the$ methodological$considerations$chapter,$but$it$is$important$for$this$literature$review$to$ understand$that$the$term$is$nebulous.$ Popularity$of$ready$meals$ Sales$figures$are$based$on$the$industry’s$definition$of$ready$meals$(both$“composite$ meals”$and$“meal$centres”).15$These$show$that,$in$the$UK,$sales$of$pre`cooked$chilled$ and$frozen$ready$meals$together$reached$£2.1bn$in$2009,83$and$are$expected$to$grow$ by$£100m$by$2013.84$The$sector$continues$to$outperform$the$larger$grocery$market,$ despite$the$economic$downturn.84$

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In$2003,$the$FSA$(Food$Standards$Agency)$estimated$that$77%$of$households$made$ use$of$chilled$ready$meals,$of$which$28%$use$them$at$least$weekly.85$These$estimates$ exceed$those$for$other$European$countries.86$Hence,$there$is$good$evidence$that$ready$ meals$are$popular$in$the$UK.$ Nutritional$value$of$ready$meals$ An$FSA$(2003)$survey18$of$the$salt$content$of$ready$meals$examined$products$from$ supermarkets’$“value”,$“standard”,$and$“premium”$ranges.$In$each$category,$a$ predetermined$number$of$named$meals$were$examined$across$retailers.$For$example,$ for$the$“standard”$range,$they$surveyed$“Chicken$Korma$and$Rice”,$“Lasagne”,$ “Shepherd’s$Pie”,$and$“Macaroni$Cheese”.$No$justification$for$the$selection$of$these$ particular$meals$was$given$in$their$report.18$ Products$meeting$these$descriptions$were$sampled$from$a$number$of$retailers.$Some$ were$frozen,$others$chilled,$some$were$own`brand,$and$others$branded.$The$selection$ method$was$not$explained,$and$not$all$supermarkets$were$included$in$the$sample$for$ each$meal.$The$salt$content$listed$on$the$packaging$was$compared$with$FSA$approved$ recommended$daily$allowances$(RDA).$The$investigation$concluded$that$83%$of$ready$ meals$contained$over$40%$of$the$RDA$of$salt.18$ The$aim$of$this$survey$was$not$made$explicit.$Whilst$it$is$of$concern$that$some$meals$ had$high$levels$of$salt,$this$study$did$not$include$a$representative$sample,$its$methods$ were$not$robust,$and$its$findings$cannot$be$generalised$to$the$whole$market.$ Hopkins$(2008)$conducted$a$study$with$a$more$generalisable$methodology.$Eighty$ elderly$people$in$London$were$interviewed$about$their$eating$habits,$and$a$list$of$the$ top$20$most$popular$types$(though$not$brands)$of$“ready$meals”$was$compiled.$ Information$on$the$nutritional$value$of$these$meals,$as$produced$by$ten$different$ manufacturers,$was$sought$from$the$packaging.19$ All$meals$within$the$study$met$the$industry’s$Joint$Sodium$Working$Party$limit$for$salt$ content$per$100g.$However,$the$serving$sizes$resulted$in$the$total$quantity$of$salt$ within$some$meals$approaching$recommended$daily$limits$(defined$as$6g).$One$third$ of$the$meals$had$salt$quantities$greater$than$40%$of$the$recommended$daily$limit.19$ MSc$Dissertation$

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Again,$this$may$not$represent$the$market$as$a$whole,$but$it$gives$some$representation$ of$the$salt$content$of$meals$commonly$consumed$by$elderly$people.$ The$Consumers’$Association$(2004)$compared$the$nutritional$values$of$meals$between$ manufacturers.20$Five$named$meals$were$selected,$and$the$nutritional$values$of$ variants$of$these$as$produced$by$ten$manufacturers$were$collected$from$packaging.$ The$basis$of$the$selection$of$the$five$meals$was$not$explained.$ The$comparative$values$are$not$of$particular$interest$to$this$study,$but$it$is$notable$ that$the$quantity$of$salt$and$fat$in$some$products$was$criticised.$For$example,$a$ chicken$tikka$masala$from$Tesco$contained$47.3g$of$fat:$two`thirds$of$a$woman’s$ guideline$daily$intake.$A$beef$lasagne$from$Iceland$contained$7.5g$of$salt:$this$exceeds$ a$man’s$guideline$daily$intake.$ When$the$survey$was$repeated$in$2007,87$the$Tesco$chiken$tikka$masala$had$26.1g$of$ fat,$and$the$Iceland$lasagne$had$2.7g$of$salt,$providing$evidence$of$product$ reformulation.$Despite$this,$the$Consumers’$Association$remained$concerned$about$ the$nutritional$profile$of$ready$meals.$This$survey$is$not$generalisable$to$the$whole$ market$since$only$five$out$of$a$selection$of$many$tens$of$types$of$meal$were$sampled.$$ Whilst$the$studies$discussed$suggest$a$pattern$of$high$salt$and$fat$content$across$the$ industry,$the$nutritional$value$of$meals$across$the$market$is$not$well$described.$There$ is$no$academic$literature$comprehensively$examining$the$nutritional$value$of$ready$ meals.$Some$literature$expresses$concern$about$the$nutritional$value$of$“convenience$ foods”,$yet$the$definitions$used$in$these$papers$are$very$broad,$often$including$items$ such$as$breakfast$cereals,$crisps,$and$prepared$frozen$vegetables.21$Hence,$they$are$ unlikely$to$be$representative$of$the$nutritional$value$of$ready$meals$specifically.$$ Recent$developments$in$the$ready$meal$market$ The$ready`meal$market$is$dominated$by$supermarket$own`brands.$Competition$ between$supermarkets$in$this$sector$is$fierce,$and$characterised$by$aggressive$pricing$ and$heavy$promotion.23$The$“healthiness”$of$supermarket$ready$meals$has$become$a$ particular$focus$for$competition$between$retailers$in$recent$years.$

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In$2005,$Tesco$launched$a$“Kitchen$Cupboard$Guarantee”$across$its$ready$meal$range.$ This$assures$customers$that$Tesco$ready$meals$contain$only$ingredients$that$would$ typically$be$found$in$a$home$kitchen.22$This$development$did$not$make$statements$ regarding$“health”;$yet$it$seems$designed$to$appeal$to$consumers$by$presenting$ready$ meals$as$having$the$same$ingredients,$and$hence$similar$nutritional$value,$to$home$ cooked$food.$At$same$time,$Marks$&$Spencer$removed$artificial$flavours,$colours$and$ hydrogenated$fats$from$their$ready$meals.23$ Later,$Tesco$reformulated$many$of$its$ready$meals$to$improve$their$nutritional$profile,$ removing$large$amounts$of$salt$and$saturated$fat,$as$well$as$trans$fats,$and$artificial$ colours$and$flavours.24$As$might$be$expected,$the$other$supermarkets$have$made$ similar$changes$to$their$own$products.25`28$Such$reformulation$initiatives$are$reflected$ in$the$improvement$in$nutritional$value$of$the$products$featured$in$the$Consumers’$ Association’s$surveys$between$2004$and$2007,20,87$as$discussed$above.$ However,$not$all$recent$changes$to$ready$meals$are$nutritionally$beneficial.$An$FSA$ (2008)$review$of$published$data88$found$that$portion$sizes$had$increased$substantially$ over$the$preceding$two$decades.$For$example,$a$typical$beef$lasagne$ready$meal$in$ 1990$weighed$250g;$500g$was$typical$by$2008.$Yet,$as$the$study$notes,$it$is$unclear$ how$the$proportions$of$the$different$components$of$the$meal$have$changed.$ The$review$notes$that$the$weights$of$today’s$ready$meals$are$more$closely$aligned$ with$published$data$on$average$home`cooked$portion$sizes.88$This$perhaps$reflects$a$ cultural$change$from$ready$meals$being$consumed$occasionally$to$being$considered$a$ reliable$full$meal$replacement.$ Overall,$given$the$efforts$made$to$transform$the$products$in$the$ready$meal$market$in$ recent$years,$a$full$assessment$of$the$nutritional$state$of$the$market$seems$ worthwhile.$

Relevant!government!policy!on!food!and!nutrition! This$review$discusses$government$food$and$nutrition$policy$affecting$England.$Wales,$ Scotland$and$Northern$Ireland$have$their$own$legislative$assemblies$and$ arrangements$for$public$health$services,$under$which$some$policies$do$not$apply.$ MSc$Dissertation$

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Evidence$for$a$lack$of$cooking$skills$in$the$general$population$ For$some$years,$successive$governments$have$encouraged$individuals$to$cook$from$ scratch,$rather$than$rely$on$ready$meals.$This$is$evident$in$the$Change4Life$initiative,$ which$has$a$specific$sub$brand,$Cook4Life,$dedicated$to$promotion$of$cooking$skills.10$ The$strategic$document$Healthy0Weight0Healthy0Lives,$advocates$extension$of$cooking$ classes$in$schools$to$“give$all$young$people$the$understanding$and$skills$to$eat$more$ healthily”$(page$ix).11$$ This$policy$appears$to$assume$not$only$that$home$cooking$is$nutritionally$preferable$ to$consumption$of$ready$meals,$but$also$that$reliance$on$ready$meals$is$a$result$of$a$ lack$of$cooking$skills.$Indeed,$in$his$governmental$advisory$role,$Jamie$Oliver$has$ claimed$that$“for$the$first$time$in$history$a$large$number$of$people$of$all$incomes$ cannot$cook”.89$Yet$the$evidence$to$support$this$is,$at$best,$mixed.$ Caraher’s$(2000)$review$of$the$data$from$the$Health$and$Lifestyle$Survey,$discussed$ earlier,$also$included$data$regarding$cooking$confidence:$just$38%$of$7`$to$15`year` olds$felt$competent$to$independently$cook$a$baked$potato.44$Yet$few$seven$yearòlds$ would$be$expected$to$cook$independently$on$a$regular$basis,$with$meals$most$likely$ provided$by$a$parent$or$guardian.$Hence,$the$utility$of$this$statistic$is$unclear.$ The$Health$and$Lifestyle$Survey1$included$a$number$of$questions$on$cooking$ confidence$which$were$not$included$in$Caraher’s$review.$A$breakdown$of$confidence$ in$cooking$ability$according$to$gender$is$given$in$Table$1.$ Table!1:!Confidence!in!ability!to!cook!from!basic!ingredients!(based!on!Table!14!in!Lang! and!Caraher,!19991)!

Confidence!in!ability!to!cook!from!basic!ingredients!

Women!%!

Men!%!

Very$confident$

67.7$

38.6$

Fairly$confident$

25.5$

37.9$

Not$very$confident$

4.3$

11.5$

Not$at$all$confident$

1.4$

7.3$

Other$response$

1.2$

4.7$

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Table$1$shows$that$most$participants$had$some$confidence,$and$women$were$likely$to$ rate$themselves$as$more$confident$than$men.$This$is,$perhaps,$reflective$of$gender$ differences$within$society:$women$have$traditionally$done$much$of$the$cooking$in$the$ home.90$The$gap$between$the$genders$is$wider$in$the$more$elderly$groups,$who$are$ perhaps$more$likely$to$have$a$more$rigid,$“traditional”$view$of$gender$roles.$$ There$is$also$an$association$with$age.$For$both$genders,$cooking$confidence$is$lowest$ in$the$16`19$year$old$group,$increasing$up$to$the$34`44$year$old$group,$and$then$ decreasing.1$The$reason$for$this$decrease$in$confidence$in$the$elderly$is$unclear,$but$ could$perhaps$be$related$to$decreasing$dexterity$with$increasing$frailty.$The$survey$ also$shows$confidence$in$cooking$ability$increasing$with$household$income.1$ The$gender$gap$in$behaviour$is$wider$still:$68%$of$women$and$17%$of$men$claimed$ that$they$cooked$from$scratch$every$day.1$The$difference$perhaps$suggests$that$$ women$continue$to$do$a$large$proportion$of$household$cooking.$The$gap$between$the$ number$of$women$claiming$high$confidence$in$their$ability$to$cook$and$the$number$ claiming$to$cook$regularly$perhaps$demonstrates$a$lack$of$time,$desire$or$willingness$ to$cook$from$scratch$on$a$regular$basis.$This$challenges$the$view$that$those$equipped$ with$cooking$skills$will,$as$a$matter$of$course,$use$them.$ The$HLS$data$based$on$self`reporting,$and$so$the$rates$may$be$influenced$by$both$ social$desirability$response$bias45$and$individual’s$differing$perceptions$of$ability.$A$ high$rate$of$confidence$in$cooking$ability$is$not$necessarily$reflective$of$a$strong$ability$ to$cook:$Byrd`Bredbenner$(2004)$has$shown$that$young$adults$in$particular$have$a$ tendency$to$overestimate$their$cooking$ability.91$Furthermore,$some$participants$may$ eat$meals$cooked$from$scratch$yet$lack$the$ability$to$cook$them,$since$the$ responsibility$for$household$cooking$may$lie$with$another$individual.$ Whilst$questions$relating$to$cooking$ability$have$been$included$in$the$national$rolling$ Diet$and$Nutrition$Survey$started$in$2008,$only$headline$results$for$the$first$two$years$ have$been$published,$which$does$not$include$data$from$these$questions.92$However,$ once$published,$this$data$should$provide$a$more$up`to`date$picture$of$selfàssessment$ of$cooking$ability$in$the$UK.$

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There$are$some$indications$that$cooking$is$growing$in$popularity$in$the$UK:$2010$saw$ a$36%$increase$in$the$circulation$of$food$magazines,93$even$while$it$is$suggested$that$a$ majority$of$consumers$seek$recipes$online$rather$than$from$print$sources.94$These$ resources$are$mostly$accessed$by$women:$73%$of$the$readership$of$BBC0Good0Food0 magazine$and0Real0Food0magazine$is$female,95$whilst$65%$of$the$users$of$popular$ website$allrecipes.com$are$female.96$ This$data$is$far$from$conclusive,$but$it$may$suggest$that$those$most$engaged$with$ cookery$education$via$the$media$are$women,$who$are$already$the$most$confident$ cooks.$If$there$is$to$be$a$national$drive$to$improve$individuals’$confidence$in$cookery,$ it$may$make$sense$to$target$this$towards$men,$who$appear$both$less$confident$and$less$ engaged.$However,$if$the$drive$is$merely$to$improve$diet,$then$it$may$make$sense$to$ use$the$media$to$communicate$health$messages$to$women,$who$are$more$engaged$ with$these$media,$more$confident$to$cook,$and$more$frequently$cook$meals.$However,$ more$data$is$needed$to$assess$the$validity$of$these$conclusions.$ Legislation$around$advertisement$of$food$products$on$television$ Restrictions$on$advertisement$of$food$products$on$television$have$recently$been$ introduced.$Advertisement$of$food$products$classified$as$high$in$fat,$salt,$or$sugar$ (HFSS)$is$banned$on$children’s$channels$in$the$UK,$and$in$all$programming$of$ particular$appeal$to$children$aged$four$to$fifteen$years.97$Additionally,$HFSS$products$ may$not$be$‘product$placed’$in$any$programme$in$the$UK.98$No$such$restrictions$exist$ for$recipes$demonstrated$on$television$by$celebrity$chefs.$ Ofcom$has$expressed$frustration$at$the$industry’s$evasion$of$the$“spirit$of$the$law”,99$ with$some$advertisements$promoting$brands$associated$with$HFSS$foods$without$ advertising$the$foods$themselves.$A$notable$example$has$been$sponsorship$of$ programmes$by$Domino’s$Pizza,$ostensibly$advertising$their$delivery$service$rather$ than$the$product$itself,$as$the$latter$would$not$be$permitted.$ Concern$has$also$been$raised$about$the$criteria$used$to$determine$whether$a$food$is$ HFSS.$For$example,$the$decision$to$base$assessment$of$a$food$on$nutritional$ information$per$100g$has$been$criticised$by$manufacturers$of$foods$that$are$typically$ eaten$in$small$quantities,$such$as$cheese.100$Others$objected$to$the$classification$of$ MSc$Dissertation$

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dried$fruits$as$HFSS,$as$well$as$the$lack$of$distinction$between$natural$and$processed$ sugars.100$The$FSA$concedes$that$some$foods$that$should$logically$not$be$classified$as$ “less$healthy”,$such$as$olive$oil,$are$considered$as$HFSS$under$this$scheme.101$ The$effectiveness$of$the$legislation$is$disputed.$Ofcom’s$review$of$the$restrictions$ suggests$that$they$have$significantly$reduced$children’s$exposure$to$HFSS$ advertising.99$However,$the$resources$for$this$study$were$limited,$and$hence$it$used$ only$broad`brush$estimates$and$modelling.$ An$as`yet$unpublished,$repeated$cross`sectional$evaluation$of$the$Ofcom$regulations$ had$different$findings.$This$study$examined$actual$adverts$broadcast$and$the$ associated$viewing$figures$six$months$before$the$first$regulations$were$enforced$and$ six$months$after$full$introduction$of$the$legislation.$This$found$that$all$viewers’$ exposure$to$HFSS$advertising$had$increased$following$introduction$of$the$legislation$–$ including$those$in$the$four$to$fifteen$yearòld$age$group$(Jean$Adams,$personal$ communication,$22$July$2011).$ Failure$to$apply$HFSS$legislation$to$recipes$demonstrated$in$television$cookery$ programmes$may$represent$a$flaw$in$the$legislation,$as$the$recipes$demonstrated$are,$ to$some$extent,$being$“advertised”.$Yet,$given$that$the$legislation$appears$to$have$had$ a$perverse$effect$on$exposure$to$HFSS$advertising,$the$point$is$somewhat$moot.$ The$coalition$Government’s$“Public$Health$Responsibility$Deal”$ In$March$2011,$the$Government$launched$a$“Food$Network”$involving$specialists,$food$ manufacturers$and$retailers$as$part$of$its$Public$Health$Responsibility$Deal.$The$aim$is$ to$encourage$non`legislative$approaches$to$improving$the$food$landscape.102$The$ three$initial$foci$of$the$Food$Network’s$pledges$are:$reduction$of$use$of$trans`fatty$ acids;$salt$reduction;$and$calorie$labelling$of$foods$consumed$out$of$the$home.102$ These$pledges$are$likely$to$have$little$impact$on$the$ready$meal$industry.$As$discussed$ above,$major$retailers$have$already$gone$to$some$lengths$to$reduce$the$salt$content$of$ ready$meals,$and$all$ban$the$use$of$trans`fatty$acids$in$their$ready$meals.$

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Similarly,$the$pledges$will$have$no$direct$impact$on$celebrity$recipes.$There$may$be$a$ small$degree$of$consequential$improvement$in$the$nutritional$value$of$these$if$the$ nutritional$value$of$the$ingredients$is$improved,$but$given$that$most$ingredients$are$ fresh$rather$than$formulated,$this$seems$unlikely$to$have$a$major$impact.$

Comparisons!of!ready!meals!and!celebrity!recipes! There$are$no$academic$publications$comparing$the$nutritional$content$of$ready$meals$ and$celebrity$recipes.$Given$current$Government$policy,$which$appears$to$favour$the$ former$over$the$latter,$this$represents$a$significant$gap$in$the$literature.$

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Aim!&!Objectives! The$primary$aim$of$this$study$was$to$compare$the$nutritional$content$of$main$course$ recipes$recommended$by$celebrity$chefs$and$that$of$ready$meals$sold$in$three$British$ supermarkets$with$nutritional$standards.$ Additional$objectives,$which$aided$this$comparison,$were$to:$ 1. nutritionally$analyse$main$course$recipes$and$ready$meals;$ 2. compare$main$course$recipes$and$ready$meals$with$nutritional$standards$ promoted$by$the$Food$Standards$Agency$and$the$World$Health$Organisation;$ 3. calculate$traffic$light$labels$for$main$course$recipes$and$ready$meals,$a$per$ Food$Standards$Agency$guidance;$ 4. compare$the$nutritional$content$of$main$course$recipes$with$that$of$ready$ meals.$

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Methodological!considerations! The$design$of$this$project$required$careful$consideration$of$the$methods$to$be$used,$ especially$since$no$methodological$precedent$exists$in$the$literature.$This$section$ discusses$derivation$of$the$methods,$and$the$methodological$considerations$behind$ them.$A$full$statement$of$methods$is$given$in$the$next$chapter.$

Selection!of!comparable!samples! The$aim$of$this$project$required$a$comparable$sample$of$ready$meals$and$celebrity$ recipes.$In$the$early$development$of$this$project,$two$potential$methods$to$derive$ these$samples$were$considered.$$ One$potential$method$was$to$select$a$variety$of$named$meal$–$“Shepherd’s$Pie”,$for$ example$–$and$draw$a$sample$of$ready$meals$and$celebrity$recipes$with$these$titles.$ The$main$virtue$of$this$approach$was$that$both$samples$would$be$clearly$comparable.$ An$alternative$method$was$comparison$of$samples$drawn$randomly$from$larger$ “populations”$of$ready$meals$and$celebrity$meals.$The$main$virtue$of$representation$of$ populations$was$that$the$selection$offered$to$consumers$plays$a$part$in$whether$the$ group$as$a$whole$can$be$considered$healthy.$$ In$a$hypothetical$situation,$a$group$of$celebrity$recipes$could$be$largely$healthy,$and$a$ group$of$ready$meals$could$be$largely$unhealthy.$The$crossover$meals,$which$appear$ in$both$groups,$may$be$nutritionally$similar$given$that$they$are$preparations$of$the$ same$meal.$Yet$the$selection$drawn$for$comparison$may$not$be$representative$of$ either$group.$Hence,$this$would$not$adequately$address$whether$the$ready$meal$group$ or$the$celebrity$recipe$group$as$a$whole$was$healthy.$ Furthermore,$named$meals$are$unlikely$to$match$exactly.$It$is$probable$that$part$of$the$ appeal$of$chef’s$recipes$is$that$describe$their$personal$variant$of$a$meal,$which$may$ differ$significantly$from$the$ready$meal$variant.$For$example,$Nigella$Lawson’s$‘Cheat’s$ Pizza’$contains$no$dough,103$and$hence$differs$considerably$from$Tesco’s$‘Italian$Pizza’$

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line.104$It$is$questionable$whether$these$two$products$are$genuinely$comparable$ variations$of$the$same$meal,$or$whether$they$merely$share$components$of$the$name.$ This$may$not$hold$true$for$the$recently$published$recipe$books$that$attempt$to$mimic$ takeaway$food:81,82$these$may$be$more$closely$aligned$with$ready$meal$variants.$ However,$the$fact$that$these$books$use$imitation$as$a$form$of$differentiation$from$ others$may$lend$weight$to$the$hypothesis$that$there$is$often$a$substantial$difference$ between$recipes$and$ready$meals.$ After$consideration$of$these$options,$it$was$felt$that$comparing$data$from$ representative$samples$of$two$populations$–$ready$meals$and$celebrity$meals$–$would$ provide$the$most$validly$comparable$sample.$

Selection!of!ready!meal!sampling!frame! The$sampling$frame$was$selected$on$the$basis$of$popularity$in$the$market$in$order$to$ assure$the$generalisability$of$the$study.$ Selection$of$Supermarkets$ Ready$meals$are$most$frequently$purchased$in$supermarkets.$Specific$data$on$ supermarkets’$sales$of$ready$meals$is$out$of$the$public$domain$due$to$its$commercial$ sensitivity.$However,$it$is$clear$that$three$supermarkets$dominate$the$UK$grocery$ market$with$a$combined$share$of$63.2%:$Tesco$(30.6%),$Asda$(16.9%),$and$ Sainsbury’s$(15.7%).105$ Typically,$literature$about$the$grocery$market$discusses$the$“big$four”$ supermarkets.106$Morrisons,$the$fourth$of$the$“big$four”,$has$a$national$market$share$ of$just$11.3%105$reducing$to$just$6%$in$some$parts$of$the$country.107$Furthermore,$ Morrisons$positions$itself$as$a$“specialist$supermarket”$offering$“high$quality$fresh$ food”.108$This$perhaps$suggests$that$its$impact$on$the$pre`packed$ready$meal$market$ will$be$smaller$even$than$its$market$share$suggests.$ Additionally,$Morrisons$does$not$publish$its$grocery$inventory$on$its$website,$making$ compilation$of$a$reliably$complete$list$of$ready$meals$practically$difficult.$Hence,$it$was$ excluded$from$the$study.$ MSc$Dissertation$

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Each$of$the$remaining$supermarkets$sells$a$wide$range$of$meals,$including$own`brand,$ named`brand,$chilled,$and$frozen.$Yet,$within$the$UK$market,$chilled$ready$meals$ outsell$frozen$versions,84$supermarket$own`branded$meals$outsell$branded$ versions,23$and$“standard”$range$meals$outsell$both$healthier$and$more$expensive$ alternatives.85$As$this$study$strives$to$be$generalisable,$the$sample$will$include$the$ most$popular$selection:$chilled$standard`range$own`brand$products$from$the$three$ biggest$supermarkets$by$UK$grocery$market$share:$Tesco,$Asda,$and$Sainsbury’s.$ Defining$an$eligible$ready$meal$ In$order$to$select$a$sample,$“ready$meal”$must$be$defined.$One$approach$that$was$ considered$was$to$include$only$those$products$that$the$supermarkets$themselves$ determine$to$be$ready$meals.$Yet,$this$subjective$judgement$appeared$to$be$ inconsistent$across$supermarkets,$and$hence$this$method$was$rejected,$and$standard$ criteria$were$determined.$ A$common$industry$definition$is$that$of$the$‘composite$meal’,$which$comes$pre`cooked$ in$a$single$package$with$no$further$ingredients$and$little$preparation$required$prior$to$ consumption.15$Heating$is$typically$the$only$required$preparation.$In$her$book$on$the$ subject,109$Menlove$adds$the$requirement$for$the$product$to$be$packaged$in$a$tray$or$ bowl$in$which$it$can$be$cooked.$ This$definition$could$still$provide$a$sample$incomparable$with$that$for$celebrity$ recipes.$For$example,$prepared$sandwiches$fall$clearly$within$this$definition,$whereas$ recipe$books$are$less$likely$to$feature$such$simple$recipes.$Hence,$a$criterion$that$the$ meals$should$be$designed$to$be$served$hot$was$added.$ Furthermore,$“ready$meal”$implies$a$short$preparation$time,$which$is$not$captured$by$ the$industry$definition.$Hence,$a$criterion$that$at$least$one$recommended$preparation$ method$should$allow$preparation$in$less$than$15$minutes$was$added.$ Side$dishes,$such$as$prepared$mashed$potato,$would$fall$within$the$criteria$defined$to$ this$point.$Hence,$the$precedent$set$by$Sempos$(1992)110$and$De$Assis$(2003)111$has$ been$followed,$requiring$products$to$contain$major$components$from$at$least$two$of$ the$‘Eatwell’$food$groups112$in$order$to$constitute$a$meal.$$ MSc$Dissertation$

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The$‘Eatwell’$plate,$developed$by$the$FSA,$divides$foods$into$five$groups:$fruit$and$ vegetables;$meat,$fish,$eggs,$beans$and$other$sources$of$non`dairy$protein;$food$and$ drinks$high$in$fat$and/or$sugar;$milk$and$dairy$foods;$and$bread,$rice,$potatoes,$pasta$ and$other$starchy$foods.$The$plate$gives$a$visual$representation$of$a$balanced$diet,$ advising$that$one`third$of$the$diet$should$consist$of$fruit$and$vegetables,$one`third$of$ starchy$foods,$and$one`ninth$of$each$of$the$other$three$groups.112$Given$these$ proportions,$it$seems$reasonable$to$conclude$that$a$meal$will$contain$components$of$ more$than$one$group.$ These$criteria$still$left$a$number$of$eligible$products$that,$in$the$author’s$subjective$ opinion,$could$not$be$considered$to$constitute$meals.$Examples$included$ microwavable$rice$with$vegetables,$and$bubble$and$squeak.$It$seems$likely$that$most$ consumers$would$serve$these$as$side$dishes.$Apparently$acknowledging$this,$the$ recommended$portion$sizes$for$these$products$tended$to$be$small.$ An$eligibility$criterion$based$on$minimum$recommended$serving$size$appeared$to$be$a$ logical$way$to$overcome$this$problem.$No$precedent$for$a$weight$limit$could$be$found$ in$the$literature.$Hence,$all$eligible$products$were$arranged$by$weight,$and$a$cutòff$ determined$subjectively.$A$cutòff$of$225g$excluded$those$products$that$appeared$to$ be$side$dishes,$yet$included$baked$potatoes$served$with$fillings,$which$typically$ weighed$225g.$The$selection$of$this$criterion$was$novel$to$this$study$and$subjective.$ This,$perhaps,$represents$a$weakness$in$the$methodology$of$this$study.$ A$similarly$subjective$judgement$was$required$around$the$status$of$soups.$Whilst$ some$soups$were$excluded$by$the$above$criteria,$this$was$not$the$case$universally.$A$ tinned$soup$would$be$excluded$as$the$product$cannot$be$prepared$in$its$packaging.$ However,$an$identical$soup$in$a$microwavable$container$would$be$included.$ Furthermore,$whether$a$soup$genuinely$represents$a$“meal”$is$contentious.$Whilst$ some$people$eat$soup$as$a$meal,$many$would$eat$it$with$an$accompaniment$such$as$ bread.$All$recipes$for$soups$within$the$cookbooks$included$in$this$study$advise$serving$ with$an$accompaniment.$Hence,$to$overcome$this$confusion,$soups$were$excluded$ from$this$study.$Other$studies$of$human$nutrition$have$previously$excluded$soups$on$ similar$grounds,$and$hence$there$is$precedent$for$this$action.113,114$

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As$a$whole,$these$criteria$appear$to$generate$a$comparable$population$of$ready$meals.$ Selection$of$sample$of$ready$meals$ Based$on$the$criteria$above,$there$were$234$ready$meals$eligible$for$inclusion$in$this$ study.$A$pilot$of$the$data$collection$methods$for$both$groups$indicated$that$a$sample$ size$of$100$meals$per$group$would$be$achievable$within$the$timeframe$available$for$an$ MSc$Dissertation$project.$Assuming$that$the$nutritional$measurements$were$accurate,$ this$would$provide$a$confidence$interval$of$7.4%$at$the$5%$significance$level.$ A$random$sample$was$drawn$proportionately$to$the$number$of$ready$meals$available$ from$each$of$the$three$supermarkets$to$ensure$that$meals$from$each$supermarket$had$ an$equal$chance$of$selection.$Hence,$a$representative$sample$of$100$ready$meals$was$ generated.$For$clarity,$(given$that$the$term$“ready$meal”$is$unspecific),$this$group$will$ be$referred$to$as$the$“prepared$meals$group”.$

Data!collection!methods!for!prepared!meals!group! Collection$of$nutritional$values$ The$included$supermarkets$display$ready$meals’$nutritional$information$on$product$ packaging$and$on$their$websites.$This$is$accessible$and$its$accuracy$is$legally$ guaranteed.115$Independent$laboratory$analysis$of$product$samples$would$be$ preferable$to$ensure$consistency$of$measurement,$but$such$analysis$would$be$ financially$and$temporally$impractical$for$an$MSc$dissertation$project.$Hence,$the$ websites$provided$the$data$for$the$prepared$meals$arm$of$this$project.$ Collection$of$fruit$and$vegetable$content$ Some$planned$analyses$required$an$estimation$of$the$fruit$and$vegetable$content$of$ meals.$However,$without$a$complete$list$of$quantities$of$ingredients,$this$is$impossible$ to$calculate.$Since$the$analyses$divide$products$into$three$groups$(“less$than$40%”,$ “40%$to$60%”,$and$“more$than$80%”),$only$a$broad$estimation$of$content$is$required.$ Generally,$when$large$quantities$of$fruit$or$vegetables$are$included$in$a$meal,$their$ percentage$by$weight$is$stated$in$the$ingredients$list.$Hence,$where$the$fruit$and$ vegetable$content$of$a$product$was$stated,$it$was$taken$as$stated.$If$the$percentage$ fruit$and$vegetable$content$is$not$declared,$it$will$be$taken$as$less$than$40%.$ MSc$Dissertation$

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Selection!of!celebrity!recipe!sampling!frame! Selection$of$celebrity$recipe$books$ Given$that$the$prepared$meals$sample$was$chosen$on$the$basis$of$popularity,$the$ celebrity$recipe$sample$was$chosen$using$similar$means.$The$celebrity$recipe$sample$ intended$to$include$the$bestselling$books,$yet$data$on$bestselling$books$across$ retailers$was$unavailable.$$ However,$data$on$Amazon’s$UK$bestselling$books$was$readily$available.$Amazon$is$ thought$to$account$for$a$large$proportion$of$UK$book$sales,$including$more$than$70%$ of$online$sales.116$Given$this$share$of$the$market,$it$seems$unlikely$that$its$bestselling$ titles$will$differ$considerably$from$those$elsewhere,$hence$use$of$this$data$does$not$ represent$a$significant$threat$to$the$generalisability$of$the$study.$ A$“celebrity$recipe$book”$was$defined$as$a$book$which$was$credited$to$an$individual$ chef$and$which$was$selfìndentified$on$the$cover$as$a$tieìn$volume$to$a$TV$series$ broadcast$on$one$of$the$five$terrestrial$television$channels$in$the$UK.$These$ individuals$are$likely$to$be$regarded$as$“celebrities”,$and$the$combined$influence$of$a$ television$show$and$a$book$is$likely$to$be$high.$ Given$that$this$project$is$intended$to$comment$on$everyday$eating$habits,$books$which$ selfìdentified$as$containing$only$recipes$for$special$occasions$(e.g.$Christmas$recipe$ books)$or$which$did$not$contain$main$meal$recipes$(e.g.$recipe$books$dedicated$to$ cakes)$were$excluded.$ Defining$an$eligible$celebrity$recipe$ In$order$to$make$the$prepared$meals$and$celebrity$recipe$samples$comparable,$similar$ exclusion$criteria$were$applied.$The$meals$were$main$course$recipes,$designed$to$be$ eaten$hot,$with$major$components$from$at$least$two$of$the$“Eatwell”$food$groups.$As$ with$the$prepared$meals$selection,$soups$were$excluded,$and$a$minimum$serving$ weight$of$225g$applied$(in$keeping$with$the$nutritional$calculations,$this$was$based$on$ weight$of$dry$ingredients).$Since$breakfasts$are$not$commonly$available$as$eligible$ prepared$meals,$breakfast$recipes$were$excluded.$$

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Side$dishes$were$included$only$if$included$in$the$recipe.$This$is$a$similar$approach$to$ including$sides$in$the$prepared$meals$sample$only$when$included$in$the$package.$ Starters,$desserts,$and$drinks$were$excluded.$ Selection$of$sample$of$celebrity$recipes$ A$pilot$study$found$that$calculating$nutritional$data$for$one$recipe$took$around$30$ minutes.$Hence,$100$recipes$appeared$to$be$the$practical$maximum$to$attempt$to$ complete$within$this$study’s$timeframe.$The$five$best`selling$eligible$books$contained$ 193$eligible$meals,$allowing$a$confidence$interval$of$6.8%$at$the$5%$significance$level.$ Hence,$a$selection$of$five$books$gave$an$included$proportion$similar$to$that$for$the$ prepared$meals$group,$and$hence$generated$a$sample$with$a$comparable$confidence$ interval.$ As$with$the$supermarkets,$a$random$sample$was$drawn$proportionately$to$the$ number$of$eligible$meals$listed$in$each$book$to$avoid$a$disproportion$likelihood$of$ selection$for$the$meals$in$any$given$book.$Hence,$a$representative$sample$of$100$ celebrity$recipes$was$generated.$For$clarity,$this$group$will$be$referred$to$as$the$ “celebrity$meals$group”.$

Data!collection!methods!for!celebrity!meals!group! Estimation$of$nutritional$value$ The$variability$inherent$in$cooking$from$scratch$rendered$precise$calculation$of$the$ nutritional$value$of$a$recipe$impossible.$For$example,$the$nutritional$value$of$eggs$and$ milk$varies$with$the$seasons.$Hence,$nutritional$value$could$only$be$estimated.$ Two$methods$estimating$nutritional$value$for$celebrity$meals$were$considered.$The$ first$was$to$calculate$the$nutritional$value$of$the$recipes$on$the$basis$of$the$nutritional$ value$of$the$raw$ingredients.$The$second$was$to$calculate$the$nutritional$value$of$the$ meals$post`cooking.$ Calculation$of$nutritional$value$post`cooking$requires$calculation$of$the$weight$loss$or$ gain$during$cooking.$Where$a$recipe$lists$‘100g$of$rice’,$the$weight$gain$on$cooking$ must$be$calculated$in$order$to$use$data$on$the$nutritional$value$of$‘cooked$rice’,$since$ MSc$Dissertation$

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100g$of$dry$rice$does$not$make$100g$of$cooked$rice.$Some$data$on$weight$change$is$ available$in$McCance$and$Widdowson,117$a$compilation$of$food$tables$giving$the$ nutritional$value$of$foodstuffs$as$experimentally$derived$by$the$Royal$Society$of$ Chemistry.$Yet$the$available$data$on$weight$change$is$incomplete,$as$is$the$nutritional$ data$for$cooked$foods.$Raw$ingredients$are$more$extensively$catalogued$in$both$ McCance$and$Widdowson,$and$the$UK$Food$Tables$that$underpin$WinDiets$software,$ which$allows$calculation$of$the$nutritional$value$of$recipes$from$entry$of$their$ ingredients.$ Hence,$it$was$decided$to$base$the$calculations$on$raw$ingredient$data.$When$ manufacturers$calculate$prepared$meals’$nutritional$value,$this$is$often$using$the$same$ method,115$so$there$is$a$degree$of$consistency$across$the$groups$in$this$approach.$ Calculation$of$fruit$and$vegetable$content$ As$quantities$of$all$raw$ingredients$are$known,$the$proportion$of$the$recipes’$weight$ consisting$of$fruit$and$vegetables$can$be$calculated$directly.$ $

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Methods! Data!collection!methods! Methods$for$celebrity$meals$group$ The$top`five$eligible$recipe$books$on$20$December$2010$were$determined$from$the$ Amazon$Food$&$Drink$bestsellers$list,$and$assessed$for$inclusion.$To$be$included$in$ this$study,$the$book$must:$ 1.

selfìdentify$as$a$tieìn$to$a$television$series$broadcast$on$one$of$the$five$ terrestrial$television$channels$in$the$UK;$

2.

be$credited$to$a$single$author;$

3.

contain$main$course$recipes,$not$identified$as$exclusively$for$use$on$special$ occasions.$

The$five$books$included$in$the$study$were:$ 1.

Kitchen:0Recipes0from0the0Heart0of0the0Home$by$Nigella$Lawson$(2010)103$

2.

Baking0Made0Easy$by$Lorraine$Pascale$(2011a)118$

3.

River0Cottage0Everyday$by$Hugh$Fearnley`Whittingstall$(2009)119$

4.

Jamie’s0Ministry0of0Food$by$Jamie$Oliver$(2008)71$

5.

Jamie’s0300Minute0Meals$by$Jamie$Oliver$(2010)120$

Each$recipe$in$each$book$was$assessed$according$to$the$following$inclusion$criteria.$ The$recipe$must:$ 1.

be$identified$as$a$main$course;$$

$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ a$This$book$was$on$sale$in$December$2010,$despite$a$copyright$notice$stating$that$it$was$published$in$

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2.

not$be$described$as$suitable$only$for$special$occasions;$

3.

be$designed$to$be$eaten$hot;$

4.

contain$major$components$from$at$least$two$of$the$‘Eatwell’$food$groups;112$

5.

have$a$recommended$serving$size$of$at$least$225g$(by$weight$of$raw$ ingredients);$

6.

not$a$soup$or$breakfast$recipe.$

Lists$of$eligible$recipes$from$each$book$were$compiled$in$a$spreadsheet$and$items$ were$sequentially$numbered.$The$number$of$recipes$required$from$each$book$in$order$ to$give$a$proportional$sample$of$100$was$calculated.$The$required$number$of$recipes$ was$chosen$from$each$book$at$random$from$the$numbered$lists,$using$a$random$ number$function.$ The$nutritional$value$of$the$selected$recipes$was$calculated$by$entering$the$list$of$raw$ ingredients$into$WinDiets$software.$$Where$the$exact$ingredient$listed$was$ unavailable$in$WinDiets$(e.g.$“basmati$rice”),$the$nearest$alternative$was$used$(e.g.$ “white$rice”).$$ Where$ingredients$were$not$stated$in$grams$(e.g.$“1$lemon”),$data$from$UK$Food$ Tables$within$WinDiets$was$used$to$convert$this$to$grams.$Where$this$data$was$not$ available,$weight$information$was$taken$from$tesco.com,$which$provided$an$estimated$ weight$of$all$loose$fresh$produce.$$ When$inexact$quantities$were$quoted$(e.g.$“a$pinch”$or$“a$dash”),$the$University$of$ North$Carolina’s$‘Dictionary$of$Units$of$Measurement’121$was$consulted$for$a$ conversion$to$grams.$ Optional$ingredients$were$excluded.$Where$a$choice$of$ingredients$was$offered,$the$ first$listed$was$included.$ The$following$data$were$recorded$in$a$spreadsheet:$

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1.

The$total$weight$of$the$recipe’s$raw$ingredients.$

2.

The$number$of$servings$offered$by$the$recipe.$Where$a$range$was$given,$the$ lower$end$of$the$range$was$taken.$

3.

The$total$energy,$protein,$carbohydrate,$sugar,$sodium,$fat,$saturated$fat,$and$ fibre$content$of$the$recipe’s$raw$ingredients.$

4.

The$fruit,$vegetable$and$nut$content$(as$defined$FSA$criteria122)$of$the$recipe$ as$a$proportion$of$the$weight$of$the$recipe’s$raw$ingredients.$

This$information$was$sufficient$to$allow$for$all$planned$nutritional$analyses.$$ Methods$for$prepared$meals$group$ The$“ready$meal”$pages$of$the$grocery`shopping$websites$of$Sainsbury’s,$Tesco$and$ Asda$were$accessed.$Where$alternative$but$synonymous$descriptions$were$used$(e.g.$ “prepared$meals”),$these$pages$were$also$accessed.$The$products$listed$on$these$pages$ were$assessed$for$inclusion$in$the$study.$To$be$included,$a$product$must:$$ 1.

be$from$the$supermarket’s$own`brand$standard$range$(i.e.$excluding$the$ “healthier”,$“value”,$“premium”,$etc.$sub`brands);$

2.

be$chilled$(not$frozen);$$

3.

be$designed$to$be$eaten$hot;$

4.

be$contained$within$a$single$package,$in$which$it$could$be$cooked;$

5.

have$a$recommended$preparation$method$taking$less$than$fifteen$minutes;$

6.

contain$major$components$from$at$least$two$of$the$‘Eatwell’$food$groups’112$

7.

be$pre`cooked;$

8.

have$a$recommended$serving$size$of$at$least$225g;$

9.

not$be$a$soup$or$breakfast$meal.$

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Lists$of$eligible$products$from$each$supermarket$were$compiled$in$a$spreadsheet$and$ items$were$sequentially$numbered.$The$number$of$products$required$from$each$ supermarket$in$order$to$give$a$proportional$sample$of$100$was$calculated.$The$ required$number$of$products$from$each$supermarket$was$chosen$at$random$from$the$ numbered$lists$using$a$random$number$function.$ The$information$pages$for$the$selected$products$were$consulted,$and$the$following$ information$recorded:$ 1.

The$total$weight$of$the$product.$

2.

The$number$of$servings$offered$by$the$product.$Where$a$range$was$given,$the$ lower$end$of$the$range$was$taken.$

3.

The$calorie,$protein,$carbohydrate,$sugar,$sodium,$fat,$saturated$fat,$and$fibre$ content$per$100g.$

4.

The$percentage$of$the$product’s$weight$consisting$of$fruit,$vegetables$and$nuts$ (as$defined$by$FSA$criteria122)$as$declared$in$the$ingredients$list.$Where$no$ figure$was$declared,$this$was$taken$to$be$less$than$40%.$

This$information$was$sufficient$to$allow$for$all$planned$nutritional$analyses.$

Analytical!methods! Analyses$made$use$of$Microsoft$Excel$and$Minitab$15$software.$ Comparison$of$fruit,$vegetable$and$nut$content$ The$data$for$fruit,$vegetable$and$nut$content$of$each$meal$was$not$continuous$due$to$ the$limited$data$collection$method$available$for$the$prepared$meals$group,$but$was$ considered$in$the$following$categories:$80%.$The$ proportion$meals$in$each$group$falling$within$each$category$was$compared,$and$a$chi` squared$analysis$was$used$to$determine$whether$a$statistically$significant$difference$ existed$between$the$two$groups.$

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Comparison$of$proportion$of$meals$classified$as$high$in$fat,$salt,$or$sugar$(HFSS)$ by$FSA$criteria$ The$nutritional$data$for$each$meal$in$both$groups$was$be$compared$with$FSA$ criteria122$to$determine$whether$it$was$classified$as$HFSS.$While$the$procedure$for$ calculating$the$nutrient$profile$of$a$product$included$calculation$of$a$score,$the$ procedure$was$such$that$this$was$not$scalar:$the$HFSS$or$not$HFSS$outcome$was$ dichotomous.$The$proportion$of$each$group$classified$as$HFSS$was$compared,$and$the$ difference$assessed$for$statistical$significance$through$chi`square$testing.$ Comparison$of$nutritional$content$per$100g$ The$nutritional$data$for$meals$in$both$groups$was$shown$from$examination$of$ histograms$to$be$non`Normal$for$most$macronutrients.$Hence,$the$median$figure$for$ quantity$of$each$macronutrient$per$100g$of$each$meal$was$compared$between$the$two$ groups,$and$differences$were$tested$for$statistical$significant$using$Mann`Whitney$ tests.$ Comparison$of$macronutrients$by$percentage$energy$ The$percentage$of$energy$derived$from$each$macronutrient$was$calculated$for$each$ meal.$The$differences$in$results$between$groups$were$tested$for$significance$using$a$ series$of$Mann`Whitney$tests.$ The$median$percentage$of$energy$derived$from$each$macronutrient$was$compared$ with$WHO$(2003)$nutritional$goals$for$the$avoidance$of$diet`related$chronic$ disease.123$Differences$in$the$proportions$of$each$group$meeting$these$goals$were$ tested$for$significance$using$chi`square$tests.$ Comparison$of$nutritional$content$per$portion$$ Portion$size$is$an$important$consideration$when$calculating$the$nutritional$value$of$a$ meal.$A$product$that$appeared$well$balanced$according$to$nutritional$analysis$per$ 100g$could$be$rendered$poorly$balanced$in$the$wider$context$of$an$individual’s$diet$by$ a$large$portion$size.$Hence,$the$median$figure$for$quantity$of$each$macronutrient$per$ portion$of$each$meal$was$compared$between$the$two$groups,$and$differences$were$ tested$for$statistical$significant$using$Mann`Whitney$tests.$$

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These$were$also$compared$with$40%$of$the$Guideline$Daily$Amounts$(GDA)$of$each$ macronutrient$as$recommended$by$the$UK$Committee$on$Medical$Aspects$of$Food$and$ Nutrition$Policy$(1991).124$Previous$studies$have$used$40%$GDA$as$a$cutòff$for$a$ reasonable$proportion$to$be$contained$in$a$single$meal.19$ KruskallPWallis$testing$for$variation$between$subPgroups$ Kruskall`Wallis$testing$was$used$to$detect$significant$differences$between$individual$ recipes$books$included$in$the$celebrity$meals$group,$and$also$between$individual$ supermarkets$included$in$the$prepared$meals$group.$ Traffic$light$labelling$analysis$ Each$meal$was$assigned$a$“traffic$light”$colour$for$each$of$four$macronutrients$ according$to$the$FSA$(2007)$guidance$on$its$recommended$traffic$light$scheme.125$ Unlike$most$supermarket$schemes,$the$FSA’s$scheme$does$not$apply$a$traffic$light$for$ calorific$content.$ These$guidelines$could$not$be$followed$exactly.$The$guidelines$allow$for$a$higher$total$ sugar$content$to$be$assigned$a$green$“traffic$light”$in$situations$where$a$large$ proportion$of$the$sugar$is$derived$from$natural$sources.$The$data$collection$method$ used$in$this$study$does$not$allow$for$calculation$of$the$proportion$of$sugar$derived$ from$natural$sources.$Hence,$the$lower$limit$for$the$green$“traffic$light”$for$sugar$was$ applied$throughout.$

Ethics!and!funding! Ethical$approval$was$not$required$as$this$project$did$not$involve$human$subjects,$and$ relied$solely$on$published$information.$The$project$did$not$incur$large$financial$cost,$ as$the$recipe$books$required$were$borrowed$from$the$local$City$Library.$Small$ ancillary$costs,$such$as$interlibrary$loans,$were$met$personally.$

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Results! Summary!of!data!collected! Celebrity$meals$data$ The$five$recipe$books$contained$651$recipes,$distributed$as$shown$in$Table$2.$Of$these,$ 301$were$main$course$recipes,$of$which$193$met$the$inclusion$criteria$for$the$study.$$ Some$main$course$recipes$were$for$only$one$component$of$the$course$–$typically$the$ meat$–$and$hence$not$eligible$for$inclusion.$Several$books$contained$recipes$for$cold$ lunches,$which$did$not$meet$the$inclusion$criteria.$$Baking0Made0Easy$included$a$large$ number$of$dessert$recipes,$hence$its$disproportionately$low$inclusion$rate.$ Table!2:!Recipes!considered,!eligible,!and!included!by!recipe!book!

Recipes! considered!

Recipes!eligible! n$(%$of$considered)!

Recipes!included! n$(%$of$eligible)!

30!Minute!Meals$

50$

49$(98.0)$

25$(51.0)$

Baking!Made!Easy$

110$

13$(11.8)$

7$(53.8)$

Ministry!of!Food$

154$

43$(27.9)$

22$(51.2)$

Nigella!Kitchen$

145$

48$(33.1)$

25$(52.0)$

River!Cottage$

192$

40$(20.8)$

21$(52.5)$

Total!

651$

193$$(29.6)$

100$(51.8)$

Recipe!book!

$ Prepared$meals$data$ The$“ready$meals”$(or$equivalent)$sections$of$the$three$supermarkets’$websites$ contained$1,449$products.$Of$these,$234$(17%)$were$eligible$for$this$study.$The$ distribution$of$these$across$the$supermarkets$is$shown$in$Table$3.$ The$commonest$reason$for$exclusion$was$not$being$from$the$supermarket’s$own` brand$standard$range$(n=595).$This$was$used$as$a$screening$criterion,$and$these$ meals$were$not$considered$against$the$other$exclusion$criteria.$The$remaining$575$ excluded$products$were$most$commonly$excluded$for$not$having$major$components$ MSc$Dissertation$

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from$two$of$the$“Eatwell”$food$groups.$All$three$supermarkets$included$side$dishes$in$ their$“ready$meal”$range,$explaining$the$high$rate$of$exclusion$on$this$basis.$ Table!3:!Products!considered,!eligible,!and!included!by!supermarket!

Supermarket!

Products! considered!

Products!eligible!! Products!included! n$(%$of$considered)! n$(%$of$eligible)!

Asda!

410$

78$(19.0)$

33$(42.3)$

Sainsbury’s!

514$

58$(11.3)$

25$(43.1)$

Tesco!

480$

98$(20.4)$

42$(42.9)$

Total!

1404$

234$(16.7)$

100$(42.7)$

$ Summary$of$data$completeness$ 55%$of$the$products$in$the$prepared$meals$group$did$not$declare$their$fruit,$vegetable$ or$nut$content,$and$hence$this$was$assumed$to$be$less$than$40%.$The$proportion$of$ meals$giving$no$fruit,$vegetable$or$nut$content$declaration$varied$substantially$ between$supermarkets$(Asda$27%,$Sainsbury’s$68%,$Tesco$69%).$Otherwise,$the$ sample$data$set$for$both$groups$was$complete.$

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Analytical!results! Comparison$of$fruit,$vegetable$and$nut$content$as$a$proportion$of$product$weight$ The$results$of$this$analysis$are$shown$in$Table$4.$There$was$a$substantial$difference$ between$the$groups,$with$a$larger$proportion$of$the$ready$meals$group$containing$ little$fruit,$vegetable$or$nut.$$ A$Fisher’s$exact$test$comparing$the$proportions$across$all$four$categories$of$fruit,$ vegetable$and$nut$content$(i.e.$with$3$degrees$of$freedom)$is$statistically$significant$ (p