N° 1 | May 2006

Can we change the way we eat ? What are the barriers ?

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Food consumption is a target end-point for many interventions designed to lead to a healthy life-style. Particular aspects of food consumption that are widely agreed to be healthy choices include increased eating of fruits and vegetables. However in many dietary modification trials, which may include intensive interventions including behavioural modification, tailored targets and motivational interviewing, the outcome has in general been poor with a reported advantage over several years of one serving of fruit and vegetables per day compared with the target of five per day. Why is it so difficult to change eating behaviour in a direction that everyone agrees would be beneficial to health ? Why do people appear to be unwilling or unable to make healthy choices in their diet?

Eating: attitudes, intentions and behaviours

One problem is that making a choice between different foods appears to be an act of self-will, or a purely conscious decision. However, this decision process contains three major elements: an attitude, an intention and the behaviour. It should be remembered that eating itself is 100% behaviour; it is an action we ultimately carry out with our own hands. The issue is that it is relatively easy to hold an attitude (for example, ‘I want to be healthy’), and also quite easy to have an intention (for example, ‘I intend to eat more fruits and vegetables’) but it is rather difficult to convert the intention into a behavioural action. This is called the ‘intention-behaviour gap’. We may all have good intentions but fail to implement them whilst congratulating ourselves on possessing sensible aims. One reason for this is that eating is not such a simple act as it seems. Indeed, eating comprises integrated behaviour sequences which together form our eating habits. These habitual patterns are extremely resistant to change.

What supports our eating habits ?

Psychologists are well aware that the best predictor of future behaviour is past behaviour. One important aspect of eating is that it confers pleasure. For some people, the sensory pleasure of eating is the most important form of pleasure in their lives. This pleasure sensation constitutes the ‘reward’ that helps to hold behavioural habits in place. One other feature of habits is that, although they are personal and individual, they are supported and maintained by the environment. Some features of the environment in which our current habits are expressed include the idea of a competitive market, aggressive marketing by the food industry and advertising targeted at the consumer. The habits are also supported by existing cultural values which make different food choices more or less prized. Although we may lament the introduction of a ‘fast food’ mentality, it is not a crime to eat in McDonalds, nor is it a sin. Indeed, a certain part of the economic system is specifically designed to promote cultural acceptability of fast foods.

What are the opportunities to eat more fruit and vegetables?

Within this economic and cultural climate, what are the opportunities to break-up unhealthy eating habits and insert more fruits and vegetable onto our platters of food choice ? It is unlikely that expecting individuals to ‘go it alone’ will be very effective. The culture has to change to place a high cultural value on eating fruits and vegetables. Such cultural values must be incorporated into economic strategies so that the values can exert pressure on market forces. That is, fruits and vegetable must be advertised and marketed with the same financial intensity as their competitors bring to bear. Government agencies could help to balance the market through the introduction of favourable pricing strategies. Some people have remarked that the degree of social engineering involved makes this an unlikely scenario. However, even partial changes could lead to significant health benefits. From a theoretical, and practical, perspective we have to work on liking and wanting. Together these will form enduring habits. There are some encouraging signs; recently in the UK one major food group reported a 10% decrease in sales of savoury pies, cakes and snacks – mostly containing high levels of fats, sugars and salt. An increase in the strength of collaboration between producers and the market would help individuals to convert their intentions into active behavioural choices. The intention is present; it simply needs to be liberated. Given that some improvement can be achieved in helping people to express their desired intention, do fruits and vegetables have the necessary sensory appeal (the ‘pleasure factor’) to compete with synthetically manipulated artificial assaults on our taste buds ? The answer is yes; fruits and vegetables have distinctive rewarding tastes that can lead to the establishment of healthy habits. The key is to start early in life to expose children to a diversity of healthy tastes. Changing food habits in adults is difficult. It is much better to start off in life with the desirable healthy habits.

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