Healthy s 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 Belief: Cost Belief: Sensory Attitude towards health Health Motivation Actual Behaviour 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 s 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 Lifestyle Questionnaire Physical Activity Questionnaire NANS Dataset (n=1500) Anthropometric Data e.g. BMI Biological Samples (Blood & Urine) 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 groups Strongly disagree Disagree Somewhat disagree Neither Somewhat agree Agree Strongly agree 1 2 3 4 5 6 7 Healthy 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 5.3 (0.9) α = 0.808
Tertiles of healthy 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 1. Taste 2. Convenience 3. Health & Nutrition 4. Cost 5. Weight control Medium healthy 1. Taste 2. Health & Nutrition 3. Convenience 4. Cost 5. Weight control Strong healthy 1. Health & Nutrition 2. Taste 3. Weight control 4. Cost 5. Convenience
Food consumption across tertile of healthy Weak healthy eating attitude Moderate healthy Strong healthy eating attitude Mean SD Mean SD Mean SD % contribution of fat to energy Food pyramid level 1 (gram/day) Food pyramid level 2 Food pyramid level 3 Food pyramid level 4 Food pyramid level 5 35.5 (6.3)* (a) 34.2 (5.9)* (b) 33.9 (6.2)* (b) 84 (59)* (a) 71 (52) *(b) 68 (45)* (b) 232 (109) 224 (95) 226 (108) 260 (197) 291 (216) 279 (191) 197 (156)* 274 (178)* 339 (201)* 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 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
BMI and energy expenditure across tertile of healthy Weak healthy eating attitude Moderate healthy 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 Watching television hrs/week Exercise minutes/week 64.8 (61.6)* (a) 58.7 (61.5)* (a) 52.4 (56.5)* (b) 21.7 (10.8)* (a) 18.8 (9.3)* (b) 17.7 (9.3)* (b) 91 (195) 100 (172) 109 (135) * Indicates statistical difference and abc subscripts denote significant differences within groups
Socio-demographic profile across tertile of healthy 1 Population Weak healthy Moderate healthy Strong healthy % % % % 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 2 Population Weak healthy Moderate healthy Strong healthy % % % % 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 % contribution of fat to total energy FoodPyramid1 (Fats, sugary snacks) Foodpyramid2 (Meat, fish, eggs) Foodpyramid3 (Milk, cheese, yogurt) FoodPyramid4 (fruit and vegetables) FoodPyramid5 (Bread, cereals, potatoes) One portion (g/d) B Sig. Odds Ratio Lower Upper - -0.03 0.05 0.97 0.94 1.00 30-0.01 0.00 0.81 0.72 0.92-0.00 0.21 1.00 1.00 1.00-0.00 0.72 1.00 1.00 1.00 80 0.00 0.00 1.29 1.17 1.42-0.00 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 s 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 s 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 s 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 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 Motivated by health & nutrition Difficulty in meeting guidelines Support through NPD and focus on dietary control Target group Female, older adults
Acknowledgements Department of Agriculture FIRM funding NANS fieldwork team Survey participants