Why don't we eat well?

Knowledge of what constitutes a healthy diet

Good nutrition matters for good health.  Dietary factors make a significant contribution to the risk of cardiovascular disease, cancer, arthritis, osteoporosis, diabetes and mental health.  Together with habitual physical activity, food is also the critical factor for risk of obesity.  But despite the growing evidence of the importance of healthy eating, surveys show that actual dietary habits are still far from the recommended diet. 

The National Diet and Nutrition Survey (NDNS) collects detailed data on dietary intakes in the UK. The most recent NDNS survey shows that adults are consuming too much saturated fat (13% of total energy intake, compared with a population average goal of 11%), not enough fibre (around 13g compared to an average target of 18g per day) and no where near enough fruit and vegetables (average intake of 2.4 portions per day compared to the target of 5 portions per day).

However, recent consumer attitudes surveys conducted by the Food Standards Agency show that most people have a good idea of the role different foods play in a healthy diet. People understand what foods they should be eating more of, such as fruit and vegetables and which foods they should be eating less of, such as foods high in fat and foods and drinks rich in sugar. Other work also suggests that the same awareness of the importance of physical activity exists. In most cases lack of knowledge is not the primary reason that most people do not have a healthier diet.

Dietary knowledge doesn’t translate into action

The prevalence of chronic disease in the Western world is often attributed to the change in dietary habits over the last couple of decades or so. Certainly for those conditions listed above, the dietary contribution may be significant. General healthy eating recommendations for most individuals however have remained consistent over the past 20 years. Consuming a diet rich in unrefined (fibre-rich) starchy foods, plenty of fruit and vegetables, with modest amounts of lean meat (or alternatives), fish, including oily fish and low-fat dairy products while reducing sugar-rich and fat-rich foods leads to a diet consistent with good health and improved weight control.

Although obesity is not the only condition affected by dietary habits, it is probably the most visual evidence that there is a clear a mismatch between what consumers know to be the best options for optimal health, and what they do in practice. Lifestyle choices are often made for complex reasons. The environment that we live in and the pressures of our daily lives often create barriers to healthier choices.

Barriers that hinder making the healthy choice

Living a healthier life is often seen as simply too challenging. Lack of time is often cited as a reason for not making healthier choices. In a large study in Europe, younger adults and those with a higher level of education were mostly likely to say that a busy lifestyle or long work hours squeezed time for preparing food, reinforcing the idea that cooking healthier food is time consuming. Avoiding family food arguments at the end of a busy day often means healthier choices are sacrificed for the sake of harmony in the limited time working parents have with their children.

Healthy lifestyle choices are also driven by real and perceived issues of cost and access. In theory it is possible to choose a healthy, albeit limited, diet on a low-income. However evidence suggests that those who live on a tight budget do tend to select foods that add up to a less healthy diet.  For those with small incomes the perception that healthy food equals expensive food, may act as a greater barrier when attempting to change eating habits. The question of whether ‘food deserts’ – where access to healthy food is limited - actually exist is largely unproven. However, if the perception is there it can become a real barrier for some individuals.

Pester power

People also have to deal with external pressures that undermine healthy choices. The almost permanent availability and marketing of calorie-rich, oversized food presents challenges for most of us. Parents suffer the added problem of pester power in the supermarket or at home and children’s food desires are rarely driven by a health agenda. A survey by National Opinion Poll (NOP) showed that most mothers (always or often) respond to requests from their children to buy less healthy foods.

Our modern lives also offer so much opportunity to do so very little in terms of physical activity. The lure of sedentary activities such as computer games and television and the use of labour saving devices (e.g. lifts, TV remote controls) means that we need expend very little energy in physical activity. 

Self image

People often have a very poor perception of their own weight status and may fail to realise that the health risks of obesity apply to them. In a study of parents of children aged 7-8 years almost half of the overweight parents thought their weight was about right and only a quarter of overweight children were correctly identified as overweight by their parents.

We often rely on comparisons with others to define our own body size, so if we are surrounded by increasing numbers of people carrying excess weight, we don’t always recognise obesity in ourselves or our children. Obesity is often viewed and portrayed by the media as an extreme condition, or a disease in its own right. We tend to believe we are invincible – obesity can seem to be something that happens to others and not something that can creep up on us over many years.

How do we tackle these barriers?

The World Cancer Research Fund (WCRF) in their recent report on Food, Nutrition, Physical Activity and the Prevention of Cancer spoke about the importance of a healthy level of body fat alongside recommendations to increase the proportion of plant based foods in the diet, to limit intake of alcohol and red meat and to minimise foods that may promote weight gain.  The Government Foresight Report on Tackling Obesities, estimated that if we do nothing to tackle obesity, by the year 2050 nearly 60% of the UK adult population will be obese.  Evidence for the role of a healthy diet in the prevention of chronic disease is clearly increasing.  Yet the barriers expressed by the population in putting their dietary knowledge into practice are very real. 

Assisting people to make healthy choices is not likely to be straightforward. Many initiatives are working across the UK to encourage healthy eating in all age groups, and within all sectors of the population accounting for factors such as cultural needs, financial constraints, nutritional knowledge etc yet to date very little evidence exists as to what works in the long term and with positive health outcomes for overall good health. 

What has become clear though, is that individual efforts are no longer going to be enough on their own.  Our environment needs to be conducive to making healthier choices the easy choice.  We all have a responsibility to facilitate this, whether as health professionals, policymakers, food industry, town planners, schools or even as role models within our own family.  An overall societal approach to changing the micro and macro environment for future health must be realised.
 
References

Henderson L, Gregory J, Irving K (2003). The National Diet and Nutrition Survey: adults aged 19-64 years. London: The Stationery Office.

Food Standards Agency, Consumer Attitudes Survey (2003).

Kearney JM, McElhone S (1999). Perceived barriers in trying to eat healthier – results of a pan-EU consumer attitudinal survey. British Journal of Nutrition  81 (suppl 2): S133-7.

Andrieu E, Darmon N, Drewnowski A (2006). Low-cost diets: more energy, fewer nutrients. European Journal of Clinical Nutrition 60 (3): 434-6.

Cummins S, Macintyre S (2002). A systematic study of an urban foodscape: the price and availability of food in greater Glasgow. Urban Studies 39(11): 2115-30.

National Opinion Poll for Ofcom (2004). Childhood Obesity – Food Advertising in Context.

Jeffrey AN, Voss LD, Metcalf BS et al. (2005). Parents’ awareness of overweight in themselves and their children: cross sectional study withing a chohort. British Medical Journal 330 (7481): 23-4.

World Cancer Research Fund/ American Institute for Cancer Research (2007).  Food, Nutrition, Physical Activity and the Prevention of Cancer: a global perspective.  Washington DC:AICR.

Foresight: Tackling Obesities – Future Choices Project Report (2007). Government Office for Science. London: The Stationery Office.