Opportunities for healthier eating in Norway
The need for a healthy diet
Overconsumption of food and being overweight are a concern in both developed and developing countries: in Norway, approximately 50% of adults are overweight or obese (BMI>30)1. Worldwide, food consumption per capita has gone up by 27% between the early 1960s and 20092. A high intake of hamburgers and sausages, boiled potatoes and soft drinks, and a low intake of wholegrain bread, fruits, berries and vegetables, has been associated with the risk for obesity in Norway3.
Developing effective initiatives that last
Government, health sector and food industry try to fight obesity with initiatives that help consumers to eat healthier, with tools such as information campaigns, nutritional labeling, making healthier food more available, improving nutritional composition of existing foods, and developing new healthy food products. However, many of these initiatives do not last or are not evaluated in the long-term. Consumers may not respond as expected: they might think a new food product has a less favourable taste when it is labelled as healthy. Other stakeholders like retailers or the food industry may not benefit from initiatives that are acceptable for consumers. It is necessary to develop initiatives that help people to eat healthier that work, but are also acceptable to most stakeholders. We investigated opportunities for such initiatives in Norway4.
Opinions from consumers and other stakeholders: what can they agree on?
To identify what initiatives consumers and other stakeholders can agree on, we conducted: 1) five structured discussions (focus groups) with stakeholders from food industry, retailers, government, research, public health, and non-governmental organizations; and 2) a questionnaire based on the focus groups results, asking the opinion of 1178 Norwegian consumers on topics that were important in the focus groups. The number of focus groups in which a topic was discussed was a measure of how important a topic was to other stakeholders, while the consumers were asked to what degree they agreed or disagreed with statements, or found a topic important or not important, depending on the topic.
The importance of food education and targeting families
Most consumers (85%) agreed to some extent that food education is a good strategy to help people to eat healthier, and it was also discussed in three out of five focus groups. In addition, more new healthy foods on the market and less advertising of unhealthy food were deemed good strategies by more than 60% of consumers, and were mentioned in three focus groups. Parents, families, schools and children were deemed important target groups, with 64% of consumers saying that it is very important to focus on parents, while four focus groups mentioned family as an important target. In addition, overweight people were also described as an important target group.
A responsibility for everyone
When asked who is responsible for implementing strategies that help people to eat healthier, most consumers agreed that everyone is responsible, including consumers. When asked specifically, the food industry and health authority were deemed moderately or very responsible by 75% of consumers, and in three (food industry) and two (health authority) focus groups.
When implementing strategies, a few things are important to keep in mind: consumers want: 1) to keep the freedom to choose what they eat (93% agreed); 2) restrict unhealthy food availability for children at school (87% agreed); 3) want nutritional information on packages (84% agreed); 4) to a limited extent be involved in food trends (only 13% of consumers liked to be involved in food trends).
How to educate consumers?
There are many ways to provide food education to consumers, ranging from classes in school, TV shows, cooking classes, etc. Particularly multi-component education strategies that involve for example, food education in class, restricting access to unhealthy foods, physical activity education, parent involvement and farming or gardening activities, can be effective. Multi-component strategies have been tested in Norway with the aim to increase fruit and vegetable intake in school children but with varying success. The “Fruits and Vegetables Make the Marks” intervention did not result in a higher intake of fruit and vegetable intake5, while the Pro Children intervention did result in a moderate increase in fruit intake, both immediately and at the one-year follow-up6. Designing a successful food education intervention is difficult, and other options such as easy-to-understand labels and providing more healthy food options may help consumers in addition. Fruit and in particular vegetables should be considered for the development of many new healthy food products.
Based on: Lloyd-Williams F, Bromley H, Orton L, Hawkes C, Taylor-Robinson D, O’Flaherty M, McGill R, Anwar E, Hyseni L, Moonan M, Rayner M, Capewell S. Smorgasbord or symphony? Assessing public health nutrition policies across 30 European countries using a novel framework. vBMC Public Health. 2014 Nov 21;14:1195.
- FHI. Overweight and obesity in Norway – fact sheet, 2012.http://www.fhi.no/artikler/?id=74991.
- FAO. FAO Statistical Yearbook, 2013. Part 3: Feeding the world, Page 126. Available at: http://www.fao.org/docrep/018/i3107e/i3107e03.pdf.
- Mostad IL, Langaas M and Grill V. Central obesity is associated with lower intake of whole-grain bread and less frequent breakfast and lunch: results from the HUNT study, an adult all-population survey. Appl Physiol Nutr Metab 2014;39:819–28.
- Oostindjer M, Amdam GV and Egelandsdal B. Getting Norway to eat healthier: what are the opportunities? Scand J Publ Health 2015:43:66-75.
- Bere E, Veierød M, Bjelland M, et al. Outcome and process evaluation of a Norwegian school-randomized fruit and vegetable intervention: Fruits and Vegetables Make the Marks (FVMM). Health Educ Res 2006;21:258–67.
- Te Velde S, Brug J, Wind M, et al. Effects of a comprehensive fruit- and vegetable-promoting school-based intervention in three European countries: the Pro Children Study. Brit J Nutr 2008;99:893–903