The authors propose a restructuring of the "food as health" paradigm to "food as well-being

Background Given the increase in medications for type 2 diabetes mellitus, clinicians and patients need information about their effectiveness and safety to make informed choices. Purpose To summarize the benefits and harms of metformin, second-generation sulfonylureas, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 (DPP-4) inhibitors, and glucagon-like peptide-1 receptor agonists, as monotherapy and in combination, to treat adults with type 2 diabetes. Data Sources MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from inception through April 2010 for English-language observational studies and trials. The MEDLINE search was updated to December 2010 for long-term clinical outcomes. Study Selection Two reviewers independently screened reports and identified 140 trials and 26 observational studies of head-to-head comparisons of monotherapy or combination therapy that reported intermediate or long-term clinical outcomes or harms. Data Extraction Two reviewers following standardized protocols serially extracted data, assessed applicability, and independently evaluated study quality. Data Synthesis Evidence on long-term clinical outcomes (all-cause mortality, cardiovascular disease, nephropathy, and neuropathy) was of low strength or insufficient. Most medications decreased the hemoglobin A1c level by about 1 percentage point and most 2-drug combinations produced similar reductions. Metformin was more efficacious than the DPP-4 inhibitors, and compared with thiazolidinediones or sulfonylureas, the mean differences in body weight were about −2.5 kg. Metformin decreased low-density lipoprotein cholesterol levels compared with pioglitazone, sulfonylureas, and DPP-4 inhibitors. Sulfonylureas had a 4-fold higher risk for mild or moderate hypoglycemia than metformin alone and, in combination with metformin, had more than a 5-fold increased risk compared with metformin plus thiazolidinediones. Thiazolidinediones increased risk for congestive heart failure compared with sulfonylureas and increased risk for bone fractures compared with metformin. Diarrhea occurred more often with metformin than with thiazolidinediones. Limitations Only English-language publications were reviewed. Some studies may have selectively reported outcomes. Many studies were small, were of short duration, and had limited ability to assess clinically important harms and benefits. Conclusion Evidence supports metformin as a first-line agent to treat type 2 diabetes. Most 2-drug combinations similarly reduce hemoglobin A1c levels, but some increased risk for hypoglycemia and other adverse events. Primary Funding Source Agency for Healthcare Research and Quality.

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact

This research examines how consumers' food choices differ when healthy items are included in a choice set compared with when they are not available. Results demonstrate that individuals are, ironically, more likely to make indulgent food choices when a healthy item is available compared to when it is not available. The influence of the healthy item on indulgent choice is stronger for those with higher levels of self-control. Support is found for a goal-activation-based explanation for these findings, whereby the mere presence of the healthy food option vicariously fulfills nutrition-related goals and provides consumers with a license to indulge.

The authors explore the relationship between perceived efficacy, depth of processing, and message framing. They conduct two experiments on varying health-related issues: sexually transmitted disease and skin cancer. In both studies, the authors demonstrate that a low efficacy condition (i.e., when it is uncertain that following the recommendations will lead to the desired outcome) motivates more in-depth processing. They then show that when subjects process in-depth, negative frames are more persuasive than positive ones. In contrast, a high efficacy condition generates less effortful message processing in which positive and negative frames are equally persuasive.