Healthy eating attitudes and healthy living: An ... · PDF fileHealthy eating attitudes and healthy living: ... Food Diary Measures the what, ... (Milk, cheese, yogurt)

Healthy eating attitudes and healthy living:

An examination of the relationship between attitudes,

food choices and lifestyle behaviours in a representative

sample of Irish adults

Dr. Paul Naughton, Teagasc

Dr. Sinéad McCarthy, Teagasc

Dr. Mary McCarthy, UCC

Overview

Dietary guidelines and health

Attitude and food choice

Methodology

Findings

Discussion

Conclusion and implications

Dietary guidelines and health

Dietary recommendations and actual consumption do not coincide

on a general population level (Irish Universities Nutrition Alliance (IUNA),

2011)

On average Irish adults are not meeting the minimum

recommendations for time spent at physical activity (IUNA, 2012)

Obesity is a global epidemic (WHO, 1998; OECD, 2010)

Excess calorie consumption and inactivity are the main causes of

obesity (NTFO, 2005; CEC, 2007)

Associated with an array of non-communicable diseases including CVD,

Hypertension and Type 2 diabetes

Since 1990 the prevalence of obesity in 18-65 year old Irish

adults has increased significantly (IUNA, 2011)

Attitudes

For marketers the study of consumer attitudes is one of the most

important means to understanding consumer behaviour

Attitudes influence, guide, shape and predict actual behaviour

Attitude

towards

health

Health

Motivation

Actual

Behaviour

Belief: Cost

Belief:

Sensory

Belief:

Health benefits

Strongly held attitudes are a good predictor of behaviour

Research aim

The objective of this study is to examine dietary, lifestyle and

activity behaviours across varying levels of attitudes towards

eating a healthy diet

To understand the importance of healthy eating attitudes in relation

to healthy eating behaviour among Irish adults

Any attempt to influence food choice via policy or NPD must be

evidence based, targeted and culturally appropriate

National Adult Nutrition Survey

Food Diary

4 day semi weighed

NANS

Dataset

(n=1500) Physical Activity

Questionnaire

Anthropometric

Data e.g. BMI

Biological Samples (Blood & Urine)

Lifestyle

Questionnaire

Food Choice Questionnaire

motivations, attitudes & beliefs regarding food All data for each individual

linked in a relational

database using unique ID

codes

Food Choice Questionnaire

Questions derived from previously validated scales

Adapted for an Irish setting & context

83 statements

Likert scale, 1 strongly disagree to 7 strongly agree

Food Diary

Measures the what, when and where

4 days – balance of week and weekend days

Semi-weighed

All information on every food consumed recorded

Time, Location, Preparation of meal snack, All constituents in the

meal/snack, Recipes

Identifying the healthy eating attitude groups

Healthy eating attitude statements Mean (SD)

It is important that the food I eat keeps me healthy 6.0 (1.1)

It is important that the food I eat is nutritious 6.1 (0.9)

It is important that the food I eat contains vitamin and minerals 5.6 (1.3)

It is important that the food I eat helps me control my weight 5.2 (1.5)

I always follow a healthy and balanced diet 4.4 (1.5)

I eat what I like and I do not worry about healthiness of food (R) 5.0 (1.6)

The healthiness of food has little impact on my food choices (R) 5.1 (1.5)

Composite healthy eating attitude 5.3 (0.9)

α = 0.808

Strongly

disagree

Disagree Somewhat

disagree

Neither

Somewhat

agree

Agree Strongly

agree

1 2 3 4 5 6 7

Tertiles of healthy eating attitude construct

Healthy Eating Attitude

Weak Moderate Strong

n 475 424 367

Mean (SD) 4.4 (0.7) 5.6 (0.2) 6.3 (0.3)

Min 2 5.2 6

Max 5.1 5.9 7

Strongly

disagree

Disagree Somewhat

disagree

Neither

Somewhat

agree

Agree Strongly

agree

1 2 3 4 5 6 7

Ranking of Food choice motives

Weak healthy

eating attitude

1. Taste

2. Convenience

3. Health & Nutrition

4. Cost

5. Weight control

Medium healthy

eating attitude

1. Taste

2. Health & Nutrition

3. Convenience

4. Cost

5. Weight control

Strong healthy

eating attitude

1. Health & Nutrition

2. Taste

3. Weight control

4. Cost

5. Convenience

Food consumption across tertile of healthy eating attitude

Weak healthy eating

attitude

Moderate healthy

eating attitude

Strong healthy eating

attitude

Mean SD Mean SD Mean SD

% contribution of fat to

energy 35.5 (6.3)*(a) 34.2 (5.9)*(b) 33.9 (6.2)*(b)

Food pyramid level 1

(gram/day) 84 (59)*(a) 71 (52)*(b) 68 (45)*(b)

Food pyramid level 2

232 (109) 224 (95) 226 (108)

Food pyramid level 3

260 (197) 291 (216) 279 (191)

Food pyramid level 4

197 (156)* 274 (178)* 339 (201)*

Food pyramid level 5

347 (149) 365 (156) 358 (141)

* Indicates statistical difference and abc subscripts denote significant differences within groups

Compliance with dietary guidelines

Complying with

recommendations

Population Weak healthy

eating attitude

Moderate

healthy eating

attitude

Strong

healthy eating

attitude

% % % %

Fat ≤ 35% of food energy 53 46 57 57

Fruit and veg consumption

400 g/d

21 11 23 31

Weak healthy eating

attitude

Moderate healthy

eating attitude

Strong healthy eating

attitude

Mean SD Mean SD Mean SD

Body Mass Index (BMI) 27.13 (5.1) 27.13 (5.1 26.43 (4.4)

Energy expenditure

through work MET hrs/wk 64.8 (61.6)*(a) 58.7 (61.5)*(a) 52.4 (56.5)*(b)

Watching television

hrs/week 21.7 (10.8)*(a) 18.8 (9.3)*(b) 17.7 (9.3)*(b)

Exercise

minutes/week 91 (195) 100 (172) 109 (135)

BMI and energy expenditure across tertile of healthy

eating attitude

* Indicates statistical difference and abc subscripts denote significant differences within groups

Socio-demographic profile across tertile of healthy

eating attitude 1

Population Weak healthy

eating attitude

Moderate healthy

eating attitude

Strong healthy

eating attitude

% % % %

Male 49.0 58.1 48.7 37.6

Female 51.0 41.9 51.3 62.4

18-35 years old 38.3 48.4 36.3 27.5

36-50 years old 30.2 28.0 31.8 31.1

51-64 years old 19.6 15.8 20.4 23.7

65+ 11.9 7.8 11.4 17.7

Single 34.4 43.1 33.0 24.6

Married 57.9 49.9 58.9 67.2

Widowed/Separated/div

orce 7.7 7.0 8.1 8.2

Socio-demographic profile across tertile of healthy

eating attitude 2

Population Weak healthy

eating attitude

Moderate healthy

eating attitude

Strong healthy

eating attitude

% % % %

Prof/Mang/Technical 45.7 39.0 50.9 54.7

Non manual skilled 18.7 20.5 17.5 17.6

Skilled manual 13.9 14.6 12.6 14.4

Semi-skilled/unskilled 20.0 25.9 19.0 13.3

Primary education 7.7 8.1 7.4 7.4

Intermediate 19.6 23.8 17 17.0

Secondary education 24.2 28.7 24.7 17.9

Tertiary 48.6 39.5 50.8 57.7

Demographic, consumption and energy expenditure

model to predict strong healthy attitude (1)

95% C.I. for Odds Ratio

B Sig. Odds Ratio Lower Upper

Gender (compared to men) 0.985 0.00 2.68 1.64 4.34

Age (18-35) 0.00

36-50 0.53 0.06 1.70 0.98 2.95

51-64 0.99 0.00 2.70 1.41 5.16

65+ 1.80 0.00 6.03 2.64 13.77

Social class 0.37

Marital status 0.20

BMI (Normal) 0.08

Overweight -0.14 0.53 0.88 0.56 1.34

Obese -0.57 0.05 0.56 0.34 0.94

Demographic, consumption and energy expenditure

model to predict strong healthy attitude (2)

95% C.I. for Odds

Ratio

One portion

(g/d) B Sig.

Odds

Ratio Lower Upper

% contribution of fat to

total energy - -0.03 0.05 0.97 0.94 1.00

FoodPyramid1

(Fats, sugary snacks) 30 -0.01 0.00 0.81 0.72 0.92

Foodpyramid2

(Meat, fish, eggs) - 0.00 0.21 1.00 1.00 1.00

Foodpyramid3

(Milk, cheese, yogurt) - 0.00 0.72 1.00 1.00 1.00

FoodPyramid4

(fruit and vegetables) 80 0.00 0.00 1.29 1.17 1.42

FoodPyramid5

(Bread, cereals, potatoes) - 0.00 0.11 1.00 1.00 1.00

Demographic, consumption and energy expenditure

model to predict strong healthy attitude (3)

95% C.I. for Odds Ratio

B Sig. Odds Ratio Lower Upper

Exercise < 26 min/week 0.05

Exercise 26-120 min/week (1) 0.34 0.16 1.41 0.87 2.25

Exercise > 120 min/week (2) 0.64 0.02 1.90 1.12 3.23

Work energy expenditure 0.85

Total TV watched in hrs/day -0.20 0.01 0.82 0.71 0.94

Discussion

Healthy eating attitudes are significantly and positively

associated with healthy eating behaviour (Roininen and Tuorila, 1999;

Roininen et al., 2001; Hearty et al., 2007)

Many studies have been limited by the precision of dietary assessment (Hearty et al., 2007)

FFQ <100 Items

Food Diaries > 3000 items

Healthy eating attitudes are associated with gender (Wardle et al.,

2004; NHF, 2005; Hearty et al.,2007) and age (Kearney et al., 1998; Hearty et al., 2007)

There was no relationship between healthy eating attitudes and social class

Positive attitudes towards healthy eating are positively associated with time spent at exercise (Hearty et al., 2007; Steptoe et al., 1997)

Conclusion and implications

Weak healthy eating attitude Attitude ambivalence: (taste &

convenience are equally important food choice considerations)

Optimistic bias

Target group

Emphasise the

consequences of

unhealthy lifestyle choices

NPD must consider these

issues

Male, younger adults

Strong healthy eating attitude Motivated by health & nutrition

Difficulty in meeting guidelines

Target group

Support through NPD and

focus on dietary control

Female, older adults

Acknowledgements

Department of Agriculture FIRM funding

NANS fieldwork team

Survey participants