1. Final master Thesis ABR - repositorio.conicyt.cl

2019

Master Thesis Consumer readiness towards plant-based consumption in selected Latin American Countries. MARÍA ALEJANDRA BRETTI ROBERT

SUPERVISOR:

Associate Professor F.J. Armando Perez-Cueto Eulert Associate Professor Christian Ritz SUBMITTED ON:

08 august 2019

i

ABSTRACT Introduction

There is a proved association of mal nutrition in all its forms (obesity,

undernutrition and other dietary risks) and climate change (Patterson et al.,

2019). In the last report of the Lancet Commissions this concept is defined as

“Syndemic” due to the synergy that these three main issues have to each other,

and this is a global concern. One of the recommendations to fight this situation is

move to a plant based diet (Boer, Schösler, & Boersema, 2013). The awareness

in the develop countries is growing and some of them have included

environmental sustainability in their dietary guidelines, however on Latin

American countries, this evidence seems not to be enough to make real and

consistent changes in laws and recommendations to fight this syndemic issue.

This thesis was divided in two parts, first a systematic review with the aim

of analyse the literature available published on Latin American countries

regarding plant-based diet related to climate change and sustainable diet, and

secondly a quantitative consumer survey distributed among selected Latin

American countries to determine the readiness of the consumer to move towards

a plant-based diet.

Material and methods A quantitative consumer survey was carried out through online program

surveyXact and distributed among selected Latin American countries, the

questionnaire was developed in Spanish and the distribution was made with help

of some collaborators in each country. The sampling methods was a non-

probability snowball sampling. The inclusion criteria were defined by people from

15 to 99 years old, residents of the selected countries. The results from the survey

were analysed using R and Rstudio® software, applying a fully adjustment model

and descriptive statistics.

ii

Results, discussion and conclusion The sample was composed by 827 respondents from three Latin American

countries (BL N=245; BR N=260; CL N=322) with a mean age of 30.21 years old,

most of the respondents were females and the majority of them have completed

higher education. The sample was mostly composed by omnivorous and

flexitarians (over 80% in all three countries).

The subjects were asked if they intended to change their diet to a plant-

based diet on a scale of Likert from 1 to 7, and the results show responses with

a greater tendency to change, over 5 points in most of the sample. Although most

of the respondents were omnivorous and flexitarians, a tendency to have a

willingness to change was observed, either to improve health or due to the

knowledge of global warming. This indicates that a structural change can be

made in the public policies of the countries to generate a real change. The

willingness to change diet was positively affected by the higher consumption of

fruits and vegetables and negatively affected by the higher consumption of red

meat, this finding can be due to the deep-rooted customs of consuming meat in

Latin American countries as a main course, consumers have a limitation of

conceiving food without products of animal origin as the center of the main dish.

Knowledge also affected the will, the more knowledge regarding global

warming and association with diet, the more will to change (BR. p 0.0002).and

lastly the more awareness of the benefits of a Mediterranean type of diet

increased significantly the will of change (CL. p 0.0004).

The association of knowledge, awareness and willingness to change has

been seen in other cultures and gives us hope to make changes in education

from childhood, awareness campaigns for the population and educate health

professionals to have a more educated and awareness countries, to achieve true

changes, not only at the health level of individuals, but also globally to fight the

damage that the industry generates in the environment.

iii

PREFACE This report presents the work of a master thesis that acts as the final paper

in the conclusion of the Master of Science degree in Food Innovation and Health

at the faculty of science at the University of Copenhagen.

The first part of the report systematically reviews the literature published

on global warming in Latin American countries, diet, and health, and the second

part refers to an online survey among selected Latin American countries to

determine the readiness to move toward a plant-based diet.

Associate Professor Federico Jose Armando Perez-Cueto Eulert from the

Section of Food Design and Consumer Behaviour, University of Copenhagen,

and Associate Professor Christian Ritz from the Department of Nutrition,

Exercise, and Sports, Pediatric and International Nutrition, University of

Copenhagen, supervised the thesis.

The theoretical part of the thesis was conducted at the Department of Food

Science, Section of Food Design and Consumer Behaviour at the University of

Copenhagen from February to August 2019.

iv

INDEX ABSTRACT i

PREFACE iii

INDEX iv

LIST OF FIGURES AND TABLES vii

LIST OF ABBREVIATIONS ix

BACKGROUND

Definitions 1

Background 2

SECTION 1

Systematic review

8

Introduction 9

Aim 10

Research question 10

Methodology 11

Results 12

Diet and global warming 16

Plant based diet and health 16

Implication and social motivation of vegetarianism and

veganism

17

Undergraduate thesis 20

Discussion 22

Conclusion

24

v

SECTION 2

Online survey and analysis to determine readiness to move towards a

plant-based diet in Latin American countries

25

Introduction 26

Research question 28

Study design

Data collection 28

Questionnaire 29

Data analysis 30

Results

Sociodemographic description of the sample 31

Willingness to move towards a PBD 32

Frequency of consumption 33

Willingness to move towards a PBD influenced by frequency of

consumption

34

Willingness to move towards a PBD influenced by knowledge 35

Willingness to move towards a PBD influenced by awareness

regarding GW and PBD

37

Barriers and facilitators 38

Intention to change diet influence by barriers and facilitator 39

Willingness to change diet influence by barriers and facilitator 42

Barriers and facilitators influence by diet 44

Intention to change diet and motives 47

Intention to change diet and motives for parents

50

vi

Discussion

The sample 53

Willingness to Move Toward a Plant-based Diet 54

Frequency of Consumption 55

Willingness to Move Toward a PBD Influenced by Knowledge

and Awareness Regarding GW and PBD

55

Barriers and Facilitators 56

Intention to Change Diet and Motives 57

Limitations and strength 58

Conclusion 59

REFERENCES 60

APPENDICES 67

Appendix Nº1 survey 67

Appendix Nº2 commands for Rstudio 72

vii

LIST OF FIGURES AND TABLES Tables

Table 1: Methodology 11

Figure 1: Screening of articles 12

Table 2: Analysis of articles 13

Table 3: Analysis of included theses 19

Table 4: Socio demographic characteristics of the sample 31

Figure 2: Willingness to move towards a plant based diet 32

Table 5: Frequency of consumption descriptive 33

Table 6: Willingness to move towards a PBD influenced by frequency

of consumption of certain groups of food

34

Table 7: Willingness to move towards a PBD influenced by knowledge

of specific statements

36

Table 8: Willingness to move towards a PBD influenced by awareness

regarding GW and PBD

37

Table 9: Barriers and facilitators descriptive analysis 39

Table 10: Intention to change diet influence by barriers and facilitator 41

Table 11: Willingness to change diet influence by barriers and

facilitator

43

Table 12: Barriers and facilitators influenced by diet (part 1) 45

Table 12: Barriers and facilitators influenced by diet (part 2) 46

Figure 3: Intention to change to a PBD 47

Figure 4: Motives to change to a PBD 48

Figure 5: Motives to NOT change to a PBD 49

viii

Figure 6: Intention to change to a PBD for parents 50

Figure 7: Motives to change to a PBD for parents 51

Figure 8: Motives to NOT change to a PBD for parents 52

ix

LIST OF ABBREVIATIONS • W: Willing.

• GW: global warming.

• PBD: plant-based diet.

• WTC: willingness to change.

• A: Agreement.

• OCDE: organization for cooperation and economic develop (by their

Spanish initials).

• UK: United Kingdom.

• FAO: Food and agriculture organization of the united nations.

• EEUU: United states of America.

• LATAM: Latin American countries (by their Spanish initials).

• BL: Bolivia.

• BR: Brazll.

• CL: Chile.

• FBDG: food based dietary guidelines.

1

BACKGROUND Definitions

Before starting, it is important to set some definitions for better

understanding of this document.

The association of U.K. dietitians defines a plant-based diet as a diet

based on foods derived from plants that include a few or no animal products

(Garton & Hood, 2017). However, there is still no consensus about the definition

of a plant-based diet. Authors define this as minimally processed food, which

includes fruits, vegetables, legumes whole grain, nuts and seed and excludes all

animal products (Ostfeld, 2017). For this dichotomy, it is important to not only

define the concept of a plant-based diet but also the different types of plant-based

diets found in the literature.

In this document, a plant-based diet is defined as follows:

“A diet based on foods derived from plants, such as fruits,

vegetables, legumes, whole grains, nuts, and seed, and with few or

no animal product include.”

The definition of a plant-based diet comprises many diets, which have

been defined as follows:

Veganism: this form of diet excludes all types of animal-derived products from its

daily plan (Melina, Craig, & Levin, 2016).

Vegetarianism: this form of diet excludes all types of flesh foods, such as meat,

poultry, and seafood (Baroni, Goggi, & Battino, 2018).

Pescetarianism: this form of diet contains fish or seafood, but no meat (Dagnelie

& Mariotti, 2017b).

Ovo-Lacto vegetarianism: this form of diet includes dairy and eggs, but no meat,

poultry, or seafood (Garton & Hood, 2017).

2

Flexitarianism: reduction of meat consumption to a healthy diet once in a while.

This form of diet is the most difficult to define due to the “occasional” inclusion of

meat products from once in a month to three times per week; therefore, it is

important to define the cut-off point in this particular category (Dagnelie & Mariotti,

2017b).

Background There is a proved association between malnutrition in all its forms (obesity,

undernutrition, and other dietary risks) and climate change (Patterson et al.,

2019). In the last report of the Lancet Commissions this association has been

defined as “syndemic” which means a synergistic epidemic cause for more than

2 population problems. In this case, malnutrition and climate change have

synergy strongly proved and is affecting the way of living in many places and for

many people, therefore this is today a global concern. The lancet commission

report presented a list of recommendations to resolve the current problem and

found moving toward a plant-based diet as a feasible solution (Boer et al., 2013).

Over the last decade, awareness of the impact of the food industry has

become more transparent. The food industry is responsible for 18–31% of the

greenhouse emissions: the animal husbandry sector is responsible for 18%

(Patterson et al., 2019; Steinfeld et al., 2009), and the rest is attributed to other

kinds of food industries. United Nations declare that the world´s population will

grow to 9,8 billion people by 2050, this means 30% more individuals than today.

This growing will rise the demand for foods, particularly meat, dairy and crops

(Food and Agriculture Organization of the United Nations (FAO), 2009). The food

industry is responsible for 18–31% of the greenhouse emissions: the animal

husbandry sector is responsible for 18% (Patterson et al., 2019; Steinfeld et al.,

2009), and the rest is attributed to other kinds of food industries. It is estimated

that greenhouse emissions will rise up to 150% of current levels by 2030, (Chai

et al., 2019) Therefore, the animal food sector has proven to have a greater

environmental impact than other food industries (Benedetti, Laureti, & Secondi,

2018). This is why is an urgent issue find a way to mitigate the current impact of

the actual food system. A sustainable diet rises as an alternative to fight the

current food system, sustainable diet is one with low environmental impact,

3

protective and respectful of biodiversity and ecosystems, and is nutritionally

adequate, safe, healthy culturally acceptable and economically affordable (Chai

et al., 2019). And has been proved that this type of is more environment-friendly

due to their use of fewer natural resources (Melina, Craig, & Levin, 2016).

The animal food sector impacts the environment due to: 1) normal gas

emissions from animals and manure, 2) cultivation of feed crops and pasturing,

3) deforestation of grasslands (for cultivation of feed crops for animals), 4) water

use, and 5) transportation and processing of animals, among others (Boer et al.,

2013; Raphaely & Marinova, 2014). This uncontrolled growth of the consumption

of meat products along with the industrialization of production has led to the

steady growth of gas emissions. If developing countries continue following the

trend of increasing meat consumption, as they increase their economy, a

doubling of animal production will be required by 2050 (Steinfeld et al., 2009).

Since 1991, energy demand has increased to 46% and the rate of gas

emissions to 44% due to urbanization, globalization, and economic growth

worldwide (Raphaely & Marinova, 2014). These factors also increase the demand

for animal products (Nadathur, Wanasundara, & Scanlin, 2016). In Europe, the

main source of protein come from meat (Davis, Sonesson, Baumgartner, &

Nemecek, 2010) while, in western countries, meat is regarded as a key ingredient

for healthy and balanced diets, holding a central position in meals and social

relationships (Niva, Vainio, & Jallinoja, 2017). Moreover, meat consumption has

risen from 29.6 kg per capita per year in 2000 to 34.4 kg per capita per year in

2017 worldwide according to the OCDE report of 2018. However, the paradigm

today is changing, and it has been proven that food consumption and dietary

patterns are associated with the quality of life and the environmental impact

(Benedetti et al., 2018). In UK 25% of the population had been declared that his

meat consumption has been reduce in the past few years and 34% indicate a

willingness to eat less meat. In EEUU 37% of the adults declare that they order

vegetarian meals when eating out. This numbers just from the UK and EEUU

exhibit some degree of plant- based dieting for more than hundred million people

(Rosenfeld & Burrow, 2017).

4

On the other hand, the animal food industry also has a direct impact on

human health. There is growing scientific evidence confirming the correlation

between animal food products and type two diabetes, cancer, and heart diseases

(Raphaely & Marinova, 2014; Pino, Cediel, & Hirsch, 2009; Rojas, Figueras, &

Duran, 2017; Melina et al., 2016). In 2011, the “world cancer research fund”

recommended to limit the intake of red meat to less than 500 g per week and

completely avoid processed meat (AICR & WCRF, 2018). Data provide for FAO

about the different countries and regions of Latin America show that the higher

the income of the families, the higher the consumption of animal products,

processed food, which leads to a high density diet, unhealthy and creating an

ideal environment for the develop of different diseases, such as cancer, diabetes,

obesity and heart diseases (Uauy, 2015).

In Latin American countries, according to the data obtain on the statistical

institute of each studied country, the consumption of meat or animal product

exceed for much the recommendations of the world cancer research fund

mentioned before. In Chile the consumption of flesh meat is 8.,1kg/year per

person being men with the highest numbers. Young people between 14-16 years

old had the highest consumption of proceed meats with a mean of 44 g/day. The

evidence showed before, could explain the obesogenic stage of the country with

a 74.2% of the population in overweight or obesity and the increasing numbers

of diabetes type 2 and hearth diseases (www.ine.cl). In Bolivia the consumption

of flesh meat is 66.48 kg/year and the government assure that that number will

rise with the years and the rising economy ( www.ine.gov.bo). Brazil on the other

hand is a greater consumer of flesh meat and also a worldwide exporter of meat

and crops for the food industry. The consumption per capita per year is 97 kg of

flesh meat on 2017 (https://www.ibge.gov.br/).

For Latin American countries, the impact of the animal industry is not

restricted to the amount of meat consumed per person per year, it has to do, also

with the amount of land used to cultivate the crops to feed the animals bred in

Europe. Approximately, 70–80% of the feed for animal farms in Europe is

imported from Brazil and Argentina (Davis et al., 2010). The production of soya

in South America increases the rates of deforestation, soil erosion, and gas

5

emissions, mainly due to the transport of this crop to the final destination

(Fearnside, 2008).

As suggested in the previous paragraphs there is a strong evidence that

shows that dietary patterns that have low environmental impact also are link to

good health. However despite all the evidence most of governments do not take

action •The best way for governments to do something on the subject is develop

a food based dietary guidelines (FBDGs) concentrate on heath and sustainability

objectives (Gonzalez Fischer & Garnett, 2016). A report published by FAO and

made for the food research climate network at the university of Oxford found that

not all countries have official FBDGs, of any kind, their absence may be link to

low income countries. Regarding FBDGs that integrate dietary approaches of

sustainability, only four countries where found: Brazil, Sweden, Qatar and

Germany. On the other hand, EEUU and Australia have had attempt to include

environmental consideration but with no endorsement of the government finally.

Other countries as UK, France, Netherlands and Estonia Have non-official

guidelines that incorporate sustainability (Cleveland & Gee, 2017) (Gonzalez

Fischer & Garnett, 2016). However as is described, this awareness by Latin

American countries is not enough; the will of different governments to change

laws or recommend fighting this syndemic issue is not consistent with the

changes observed around the world. To be able to create systems that promote

sustainability, growth and equity national policy plays a critical role, removing

barriers and shaping the field with standards for national and local action (Rawe

et al., 2019). If the goal is to improve the actual situation of global warming,

obesity, and other diseases, it is important to generate awareness about real

changes all over the globe.

The last global trends identify by FAO are according to many of the issues

described above. One of them is the on growing population, which will increase

the demands of the agricultural sector by 2050 by 50% compared to 2013 (Food

and Agriculture Organization of the United Nations, 2017). To satisfy agricultural

demands food industry will grow and increase the competition for natural

resources, the productions of greenhouse gas emissions and therefore further

deforestation and land degradation (Sanchez-Sabate & Sabaté, 2019). This

trends represent a series of challenges for the food industry and the governments

6

trying to find innovative systems of production that protect and enhance the

natural resource base, while increasing productivity (Rawe et al., 2019).

With all the evidence on set, it is important now, look from the consumers

perspective and how governments, dietitian’s and public health campaigns can

contribute to make this transition more effective for the good of the environment

and the populations health. Food consumer behaviours are result from strongly

held factors like taste preferences, culinary traditions and social norms (Sanchez-

Sabate & Sabaté, 2019) and some evidence found that a large part of the

population is not ready to move to a plant-based diet (Lea, Crawford, & Worsley,

2006a). However different authors have found evidence that certain groups are

more willing to change, for example, females, older people and higher-level

education are more likely to try a healthier diet (Lea et al., 2006a). Among college

age students is becoming very popular to choose a plant-based food in their daily

meals (Wyker & Davison, 2010) and in EEUU 37% of the adults declare that they

order vegetarian meals when eating out (Rosenfeld & Burrow, 2017). The

motivations to change can be diminished by the influenced of cultural and social

values and by related habits and routines (Austgulen, Skuland, Schjøll, & Alfnes,

2018) but also can be motivated by the prosocial aspects , personal aspects and

moral goals of each individual (Rosenfeld & Burrow, 2017).

According to the theory of the stage of change, there is 5 separate stage

for complete a behavioral change of the consumers (1) precontemplation, (2)

contemplation, (3) preparation (4) action (5) maintenance (Prochaska et al 1992).

In this case of changing to a plant based diet consumers on the precontemplation

stage have been found more barriers than benefits for fruits and vegetables

consumption, this means that they are not ready or even consider to change, on

difference from the consumers on contemplation stage or others more advance

(Lea et al., 2006a). Just few studies have explored willingness to reduce meat

intake and how can consumers can move on the stages of change to create an

impact on the food industry and revert the global warming (Sanchez-Sabate &

Sabaté, 2019).

7

This thesis aims to evaluate the readiness to move toward a plant-based

diet among different Latin American countries and measure the awareness and

knowledge regarding environmental issues of diet and health benefits of

changing the diet plan to a plant-based diet. The section 1 of the report consists

on a systematic review to investigate the material available about published Latin

American scientific magazines in Spanish, and the section 2 consists on a

consumer study composed by an online survey that was conducted in selected

Latin American countries to determine the readiness to move toward a plant-

based diet of that population.

8

SECTION M SYSTEMATIC REVIEW

9

Introduction

The impact of people, diet, and the food industry on climate change and

greenhouse gases is very clear nowadays (Boer et al., 2013). To globally impact

the reduction of climate change, a change in diet, switching from a traditional

western diet to a plant-based diet, reducing or completely avoiding animal

products, is recommended (Pérez-Cueto, 2015). There is a strong evidence that

shows that dietary patterns that have low environmental impact also are link to

good health (Chai et al., 2019) but, this data is mainly obtain from develop

countries which not always reflect what is happening on the developing countries

or countries with less income. Data provide for FAO about the different countries

and regions of Latin America show that population in Latin America is increasing

the income of the families and the globalization of the population is creating a

change in the population (Food and Agriculture Organization of the United

Nations, 2017) the increasing on the salaries have change the way that food is

consumed and the life style of the population. Generally is described the higher

the income the higher the consumption of animal products, processed food and

sugar, fat and salt contain in this product, which leads to a high-density diet

unhealthy and creating an ideal environment for the develop of different diseases

(Uauy, 2015) this can explain the raising numbers of diabetes type 2, hearth

diseases and obesity among the population.

This systematic search was carried out to identify, understand, and

analyze the material available in reliable search pages related to plant-based

diets and the relationship it has with climate change and the effects on the health

of individuals, to further investigate and create real changes on the public policy,

consumer behaviour and public health for the population of Latin American

countries.

10

Aim

The aim is reviewing the literature available published on plant-based diets

in Latin American countries, whether vegan or vegetarian, related to climate

change, reduction in the emission of greenhouse gases, and the effect of these

forms of diet on the health of the individuals.

Research question

¿Is there a reliable material published in Spanish, in scientific journals in

Latin America, which is related to plant-based diet and climate change Which

would help to set the scene or that would be neglected by reviewers excluding

papers in Spanish?

11

Methodology

A review of the literature published in the search engines SCIELO, which

is host of different data bases and journals in Spanish and Portuguese, mostly,

that could be compared to web of science but from Latin America and Google

Scholar was carried out using the keywords (below), creating combinations

among them to achieve as many articles as possible; only articles in Spanish

were selected and created or published in Latin America. Once the results of the

databases were obtained, the duplicate articles were removed, the rest analyzed,

and the non-relevant ones removed from the database.

Articles published after February 2019 were not included in the search.

Table 1. Methodology

The information extracted from each document includes the purpose of

the publication and a summary of it in addition to the basic information, such as

the name of the authors, the year of publication, and the place of publication. The

articles were arranged by the year of publication and analyzed.

.

Keywords Inclusion criteria Exclusion criteria

1. Global warming

2. Sustainability

3. Diet

4. Health

5. Sustainable diet

6. Ethics

7. Vegan / Veganism

8. Vegetarian /

Vegetarian

9. Greenhouse effect

gases

10. Latin America

-Publications in Spanish

Study the population in

Latin America

-Articles published since

2005

-Articles related to the

research question

-Publications in scientific

journals

-Studies carried out on

animals

-Livestock studies

-Publications found on

unreliable sites.

12

Results

Figure 1. screening of articles

A total of 155 articles were found in both the search engines after a

preliminary analysis: reading the article content, determining if the articles meet

the inclusion criteria and the research topic, and verifying they are published in

renowned scientific journals. Only 7 articles met the final inclusion criteria and

were found to be related to the relationship between global warming and a plant-

based diet.

In addition, the author selected two undergraduate theses related to the

main topic using the search engine of the same university.

Sistematic review

Articles in scielo (n=57)

Remove after screening of

repetition (n=3)

Articles not related or don´t match inclusion

criteria (n=44)

Articles for first analysis (n=10)

Articles removed (n=5)

Articles for final analysis (n=5)

Articles in GOOGLE SCHOLAR (n=98)

Remove after screening of

repetition (n=3)

Articles not related or don´t match inclusion

criteria (n=81)

Articles for first analysis (n=14)

Articles removed (n=12)

Articles for final analysis (n=2)

Articles added by the author (n=2)

13

Table 2 Analysis of Articles Title Countries

or region Author Year Publish Aim Summary

Intake of food of animal origin versus plant origin and cardiovascular risk

Chile Ángela Pino L., Gustavo Cediel G., and Sandra Hirsch B.

2008 Chilean Journal of Nutrition

To understand the published studies of mortality and cardiovascular risk related to food intake of either plant or animal origin.

The western diet is characterized by high consumption of food of animal origin, and this is associated with an increased risk of diabetes mellitus 2 and high blood pressure.

Sustainable and healthy diet? Retrospective and implications for public health

Chile Federico J.A. Pérez-Cueto


To Observe the development of the concept of sustainability in the diet and identify barriers to the adoption of this type of diets for the population

It is well known that the agricultural sector contributes 10-12% of gas emissions greenhouse effect and the demand for food is expected to increase in the coming years. That is why a reduction in the consumption diet of products of animal origin can contribute to the reduction of these gases. Latin America has the advantage that more traditional diets are primarily based on plants and legumes, so it is recommended is to go back to the roots to help reduce global warming

Food knowledge of Chilean vegetarians and vegans

Chile Jerusa Brignardello G. Lisu Heredia P. María Paz Ocharán S. And Samuel Durán A.


Determine the motivations of individuals to follow a vegan or vegetarian diet and the knowledge they have regarding to the food they carry.

The main reasons why the respondents chose their respective diets were determined: the main cause includes ethical and moral principles related to animal abuse followed by health-related issues. On the other hand, a majority of the respondents were informed by the Internet and a minority went a specialist regarding their diet. This is why health personnel can guide and help people in the most appropriate way.

14

Psychological meaning of eating meat, vegetarianism and healthy eating in university students from natural semantic networks

Mexico Ligia Maria Orellana, José ́Andrés Sepúlveda, and Marianela Denegrí.

2013 Mexican Journal of Eating Disorders

Understanding the psychological meanings that involve eating meat or being a vegetarian in university men and women

This study investigates the perception of subjects regarding the concept of vegetarianism and its specific attributes, positive or negative. The concept of vegetarianism was found to be positively associated with health and negatively associated with sickly. It also highlights the dynamics in genres and the different conceptualizations that define each concept

Nutritional advantages and disadvantages of being vegan or vegetarian

Chile Daniela Rojas Allende, Francisca Figueras Díaz, Samuel Duran Agüero.


Show recent evidence on the benefits and risks of vegan or vegetarian diets in chronic noncommunicable diseases and in the life cycle

Plant-based diets has increased the number of adherents in recent years in Western countries. This type of diet is considered as balanced and healthy, but still generates mistrust in the world of current nutrition for potential problems of nutrient deficit. The document describes the critical nutrients in the different stages of the life cycle and the benefits that the adoption of this type of food could have on the health of people.

Vegetarians on Córdoba: a qualitative analysis of practices and motivations

Argentina Maria Marta Andreatta

and

Carolina M. Camisassa

2017 Journal of Science and Technology of the 21st Century Business University

Identify and analyze the types of vegetarianism and their motivations that subjects have to adopt this type of diets

Qualitative interviews were conducted to determine the diets followed and the motivations of it. The main diets found were the flexitarianism, vegetarianism and veganism and each one with its derivations and personal adjustments. The main reasons for adopting this type of feeding were animal empathy, care of the environment, spiritual beliefs and health.

15

The water footprint and its relationship with obesity in Mexico

Mexico Lares-Michel, Mariana; Housni, Fatima Ezzahra; Aguilera Cervantes, Virginia Gabriela; Michel Nava, Rosa María; y Barragán Carmona, Maria del Carmen

2018 Mexican system of research in psychology

Determine the Relationship between the water footprint, the epidemic of obesity and the environmental impact of these in Mexico

Along with environmental problems and water scarcity, today Mexico today is facing with a nutritional crisis due to the epidemic of malnutrition due to excess. The food transition that has been exposed in the last decades changing the "traditional" rural diet for a more modern "western" diet is the main cause of the latter problem that affects and cooperates with the first two problems mentioned above, the environmental and water scarcity. It is suggested that the development of a hydraulically sustainable diet can have a positive impact on the reduction of overweight and obesity, in addition to the environmental impact

16

Although only two articles follows to the aim of this review, regarding

sustainable diet and its implications (Pérez-Cueto, 2015) and water footprint and

how it relates to the health of people (Lares-Michel, Housni, Aguilera Cervantes,

Michel Nava, & Barragán Carmona, 2018). The other articles included, have

some relation to the subject.

Diet and global warming The article of Lares-Michel of 2018 mentions that although FAO develops

and promotes sustainable diets for both health and the environment, water

footprint (WF) is not considered as the main factor within the indicators to be

measured and can be considered as a sustainable diet. Regarding the

measurement of WF of the most common diets, it is known that an omnivorous

diet has higher WF than a vegan or vegetarian diet (Rosi et al., 2017). It is also

known that the reduction of calories from a diet decreases the WF (Tom,

Fischbeck, & Hendrickson, 2016). Keeping this in mind, the document concludes

that a diet low in WF can contribute to the health of people and, also, the

environment.

Pérez-Cueto mentions in his document the impact of the food industry of

animal products on greenhouse gases and how the coordinated reduction of

consumption of this type of food greatly benefits public health and the

environment. Sustainable and healthy diets benefit everyone—the environment,

the individual, and the public health system—since cardiovascular diseases are

reduced—diabetes mellitus type 2 and some types of cancer (Pino et al., 2009;

Melina et al., 2016; Rojas et al., 2017). In addition to the reduction of greenhouse

gases (Sabaté & Soret, 2014), the author also emphasizes the responsibility of

health professionals, specifically nutritionists, to promote balanced, sustainable,

and healthy diets mainly to ensure a better quality of life, in the broadest sense

of the word, for the individual, the population, and the planet Earth.

Plant-based diet and health In relation to the benefits or contraindications of plant-based diets on the

health of people, the article published in 2017 determined the advantages and

disadvantages of a vegetarian-vegan diet from a nutritional point of view (Rojas

et al., 2017), identifying the needs of nutrients through the life cycle and the

effects on health. The authors conclude that a vegetarian diet is rich in fiber,

17

vitamin, mineral, and polyunsaturated fatty acid that contributes to good health.

However, it is very important to implement a vegetarian diet properly with the

guidance of a nutritionist to avoid deficiencies of macro or micronutrients and to

adjust to the nutritional requirements according to age, metabolic status, or the

stage of the life cycle.

With regard to cardiovascular risk related to the consumption of animal

and vegetable origin foods, the authors affirm the scientific evidence that exists

about the role of diet on the health of people. The nutritional recommendations

are based on the increase of food of vegetable origin and the decrease of food

of animal origin. The high consumption of polyunsaturated fatty acids is

associated with a reduction in cardiovascular risk, which is ultimately associated

with a decrease in mortality.

Implications and social motivations of vegetarianism and veganism In relation to the motivation to follow a plant-based diet, its meaning at a

social level, and our knowledge about this type of diet, we have found three

articles.

Regarding understanding the meaning of eating meat versus being a

vegetarian, it has been found that meat is regarded a symbol of hierarchy and

domination both in nature and related to gender, since red meat, especially, is

associated with masculinity and power while plant-based diets are associated

with femininity and weakness (Orellana, Sepúlveda, & Denegri, 2013). Despite

this, vegetarianism is considered as healthy.

When trying to understand the ways to motivate people to follow this type

of diet, a qualitative study conducted in Cordoba, Argentina, showed that there

are three major areas of motivation to change or maintain a vegetarian or vegan

diet: empathy toward animal suffering (ethics), the care of the environment, and

health. It is also important to note that this study in particular associates a vegan

diet more strictly with ethics and less strictly with health reasons (Andreatta &

Camisassa, 2017).

Regardless of the motivations that have led individuals to follow this type

of diet or lifestyle, it is necessary to follow the advice of a professional in order to

avoid any type of deficiency; since the benefits of the above have been

18

demonstrated, this diet should be health balanced (Walsh, Hebbelinck,

Deriemaeker, & Clarys, 2017). A study conducted in Chile found a lack of

knowledge of vegetarianism and veganism in most of the respondents and that

the main source of information for them is the Internet, in forums or pages, thus

giving them low confidence and keeping them less prepared for a balanced and

healthy diet.

19

Table 3 Analysis of included thesis Title Countries or

region Author year Publish Aim Summary (results)

Application of nutrition in sustainable nutrition and the role of the nutritionist in caring for the environment

Mexico Georgina Hernández Piña

2014 University of the State of Mexico. To apply for a bachelor's degree in nutrition

To inform and guide about nutrition and healthy eating and the role of health professionals with regard to caring for the environment, through a bibliographic review.

The author researched and analyzed the sources found for each aspect of nutrition and sustainability. and explaining the role of the nutritionist in sustainability. The professional can be involved in all the chain of food and his role should be find alternatives to enhance and improve the actual food system for one more sustainable. On the field of public health, the nutritionist should be oriented and teach to the population to eat in a more sustainable way and not let them be influence by the industry of highly processed foods.

Recommendations for a sustainable and healthy diet as a support to the elaboration of Ecuador food guides

Ecuador Claudia Salomé Torres Caiza

2017 University San Francisco de Quito USFQ. To apply for a bachelor's degree in nutrition

The purpose of the work is to propose recommendations for access to a sustainable and healthy diet in Ecuador through food-based dietary guidelines using the NOVA food classification.

These days there are many crises that can be related to one another in different ways: overweight and obesity, climate change, loss of biodiversity, poverty and food waste. All these problems generated the creation of a sustainable, healthy and affordable diet by FAO. Today in Ecuador the GABA is under construction and it is fundamental that these guides for the population have the sustainability criteria that are being promoted in different countries of the world and contextualized to the reality of the country. Therefore, the author of this document creates a list of 9 recommendations for a sustainable diet according to the reality of the country population.

20

Undergraduate theses The author found it relevant to add some undergraduate theses as a

source of information which, although have not been published in renowned

journals, have been published in the databases of Latin American universities.

Young professionals are taking steps to carry the issues of a plant-based diet and

global warming to information networks to create more awareness and to bring

about a change.

Table 3 shows the summary of undergraduate theses. The thesis carried

out in the Autonomous University of the State of Mexico is a review of the

literature found explaining the role of a nutritionist in sustainable nutrition, details

the role of the nutritionist in each area of performance of the profession in relation

to sustainability and how the professional can promote sustainability (Hérnandez,

2014). It has been identified in the collective food area as an area of great

influence since, in this area, the nutritionist is responsible for distributing meals

to a certain group of people; therefore, the professional can nudge a sustainable

consumption by ensuring sustainability throughout its chain of processes, from

the original raw materials to the final product that is delivered to the consumer,

going through the entire production line. In clinical nutrition, direct contact with

the patient allows the professional to provide sustainable recommendations for

each individual. And finally, the incipient incorporation of the nutritionist in the

food industry is an advantage to promote sustainability in the diets, since the

professional can be directly involved in the development of new products that go

follow the principles of sustainability.

At the University of San Francisco in Quito, Ecuador, a student completed

her undergraduate thesis with the aim of generating suggestions for constructing

a new food-based food guide (GABA by the initials in Spanish) of Ecuador and

based on the recommendation for a sustainable and healthy diet (Torres, 2017).

Ecuador is a country with a growing population of overweight and obese people,

but also face problems such as malnutrition and low birth weight. This reality is

not far from the rest of the countries in Latin America. The current diet comprises

mostly of ultra-processed foods, meats, dairy products and, to a lesser extent,

less processed foods, such as fruits, vegetables, and legumes, making it a

nutritionally inadequate diet, which places the individual at the risk of chronic

21

diseases. This type of feeding, moreover, is related to a greater environmental

impact (Röös, Karlsson, Witthöft, & Sundberg, 2015). In this document, the

author took advantage of the opportunity to build GABA in Ecuador in order to

recommend a sustainable diet, thus improving the quality of life of individuals and

reducing the environmental impact of the current diets in Ecuador. The

recommendations are similar to those given in Uruguay and in Brazil for their

respective populations. Some of the suggestions are as follows: (1) basing food

on minimally processed, local, and seasonal products; (2) avoiding consumption

of food rich in sugar, salt, and fat (ultra-processed); (3) preferring cooking food at

home and sharing it with family and friends; (4) reducing the consumption of red

meat and fish; (5) if you are going to consume fish, prefer small national

producers; (6) reducing the consumption of dairy products and replacing them

with other products rich in calcium or vegetable beverages; (7) knowing where

your food comes from and be critic with the advertising of new products. In

addition, these recommendations not only point to food directly but also the

lifestyle, such as reducing the use of plastics, using reusable bottles, and

reducing food waste. It is also important to emphasize sharing food with family

and friends gives the meal a deeper than merely nutritional essence.

22

Discussion As mentioned in the recent report published by the Lancet Commission

today, climate change, obesity, and malnutrition are firmly linked (Patterson et

al., 2019). Therefore, we cannot talk about a plant-based diet without talking

about its benefits regarding health, such as reducing cardiovascular risks

(Williams & Patel, 2017), controlling diabetes (Melina et al., 2016), and reducing

the risk of some types of cancer (Dagnelie & Mariotti, 2017a). It also has benefits

that can improve or delay climate change, reducing the emission of greenhouse

gases (Hallström, Carlsson-Kanyama, & Börjesson, 2015).

Diet and global warming:

Two articles found in this search related to both the topics show the need

for more publications in Spanish in Latin American scientific magazines on a

subject that are not only trending worldwide but is also one of the most important

major concerns for most sectors (Nadathur et al., 2016). Publications of journals

in English or other languages have far more studies, reviews, and opinion

columns compared to those found in Latin American magazines.

Plant-based diet and health.

As mentioned earlier, one cannot talk about a plant-based diet without

mentioning its positive effects on health (Pino et al., 2009; Melina et al., 2016;

Rojas et al., 2017). The articles analyzed in this review (n=2) point to a

bibliographic review of the benefits and disadvantages of a vegetarian diet for the

health of individuals; however, there is no published clinical study conducted in

Latin American countries, written in Spanish and published in scientific journals

to better understand the reality of each country.

Implications and social motivations of vegetarianism and veganism.

The articles found in this area (n=3) address the most social aspect of

plant-based diets, as perceived individuals who follow this type of diet or their

peers, Plant-based dieters see their diets as a definition of their identity

(Rosenfeld & Burrow, 2017). For society, meat or food of animal origin is still

related to hierarchy and domination of male and plants mostly found to be

associated with femininity (Orellana et al., 2013). Therefore in western societies

23

meat-based diets are the norm and vegetarians or vegans are the exception (less

than 5% of the population in UK and EEUU) (Sanchez-Sabate & Sabaté, 2019).

In this subject, we also find the motivations to change diet, the most

relevant of which are ethics, the environment, and health (Andreatta &

Camisassa, 2017). These reasons are similar in different countries and authors

can find many different motives to follow a PBD. The most commonly reasons

include animal ethic, personal health, environmental concern, religious beliefs

and some other less common are weight loss, taste, saving money and political

matters (Rosenfeld & Burrow, 2017).

A study made in Sweden to understand the attuites of vegetarians and

PBD (Corrin & Papadopoulos, 2017) show that Vegetarian diet can be perceived

more positive than vegan diet for the consumers, however, vegan diet can be

perceived as healthier. Among the consumer the strongest perceived barriers to

adopt a plant-based diet is the enjoyment of eating meat (Corrin &

Papadopoulos, 2017), and even thought studies have found that a large part of

the population is not ready to consume a plant-based diet (Lea et al., 2006a)

other studies have found that Values and attitudes towards climate change can

be predictors of willingness to reduce meat consumption and choose more

sustainable products (Austgulen et al., 2018).

Undergraduate thesis

The documents found as undergraduate thesis (n=2) were analyzed

separately since they are documents with much more material than an article,

and although they are directly related to the topic of diet and global warming, we

prefer to analyze them separately. They highlight the role of the health

professional in the care of the environment in each of their areas of performance,

making it fundamental today to train nutrition professionals on global warming

and his relation with diet to make a real impact on the population (Hérnandez,

2014).

In the second document analyzed, suggestions are made to change the

nutritional recommendations of Ecuador in order to bring about a more

sustainable and healthy diet plan (Torres, 2017). A recent study (2016) made a

screening world-wide about the food based dietary guidelines (FBDGs)

concentrate on heath and sustainability objectives, this research found only four

24

countries had integrate dietary approaches of sustainability, Brazil, Sweden,

Qatar and Germany. These included theses bring a light of hope to the new

changes. It needs to be understood that the professional nutritionists who are

walking on a professional path are worried and are generating initiatives to

ensure a change toward a more sustainable and healthy diet.

Conclusion The articles found and analyzed in this bibliographical review are

insufficient. It is essential that the scientific teams of Latin America mobilize and

conduct studies and publications that can support the symbiosis that exists

between climate change and people’s health in order to generate changes in

public policies that follow the reality of Latin America.

Undoubtedly, literature published around the world is essential as a base;

however, studies need to be conducted in the real local population in order to

adjust to the indices of each country and its local reality. It is advised not to use

the recommendations for developed countries in the case of developing

countries, as their economy, disposition of breath, and geography are completely

different.

Although some Latin American have shown progress in trying to change

public policies, these actions may be insufficient to generate changes in health

and global warming.

25

SECTION C Online survey and analysis to determine readiness to move towards a plant-based diet in Latin American countries.

26

Introduction

The influence of food choice and the food industry on global warming and

greenhouse gas is clear—if we do not bring about a positive change now, climate

change and its negative impact will move forward (Boer et al., 2013). Many

studies have been published on this subject among European countries;

however, in Latin American countries, reliable information published is limited.

Promoting consumers shifting their food consumption towards a plant-

based diet has been suggested as a key element to tackle climate change (Pérez-

Cueto, 2015). Therefore, it is important to study the population and measure their

readiness to change their habits and move forward to a plant-based diet in order

to create a global effect and make a real impact on fighting climate change.

According data found on the last OCDE report of 2018 meat consumption

has risen from 29.6 kg per capita per year in 2000 to 34.4 kg per capita per year

in 2017 worldwide. This demand on the animal food industry could rise by the

2050 (Steinfeld et al., 2009). However, the paradigm today is changing, and

consumers are shifting diets and nutrition patterns (Benedetti et al., 2018). In UK

25% of the population had been declared that his meat consumption has been

reduce in the past few years and 34% indicate a willingness to eat less meat. In

EEUU 37% of the adults declare that they order vegetarian meals when eating

out. This numbers just from the UK and EEUU exhibit some degree of plant-

based dieting for more than hundred million people (Rosenfeld & Burrow, 2017).

The drivers for this change rely in many factors the most relevant of which are

ethics, the environment, and health (Andreatta & Camisassa, 2017). These

relevant reasons are similar in different countries and across studies and authors

can find many different motives to follow a PBD. The most commonly reasons

include animal ethic, personal health, environmental concern, religious beliefs

and some other less common are weight loss, taste, saving money and political

matters (Rosenfeld & Burrow, 2017).

Latin American countries are currently undergoing economic growth, and

the consumption of animal-based food has been growing steadily (Godfray et al.,

2018). The increasing salaries salaries have changed the way that food is

27

consumed and the life style of the population, on the past few years has been

seeing an increasing on the consumption of highly processed foods, with high

energetic content, full of sugar, fat and salt. The evidence also show that the

consumption of whole grain cereals, fruits, vegetables and legumes has been

decreased in the past years. The final result of all these changes combined, is an

increasing on the obesity, hypertension and diabetes, some types of cancer and

osteoporosis (Uauy, 2015). According to the data obtain on the statistical institute

of each studied country the consumption of meat or animal product exceed for

much the recommendations. In Chile the consumption of flesh meat is

89,1kg/year per person being men with the highest numbers (www.ine.cl). In

Bolivia the consumption of flesh meat is 66,48 kg/year and the government

assure that that number will rise with the years and the rising economy

( www.ine.gov.bo). Brazil on the other hand is a greater consumer of flesh meat

and also a worldwide exporter of meat and crops for the industry. The

consumption per capita per year is 97 kg of flesh meat on 2017

(https://www.ibge.gov.br/).

It is important to clarify the market of plant-based diets and conduct further

studies to initiate a change in the population or, even more, in the public policies,

to encourage the consumption of plant-based diets and decrease the amount of

animal products consumed by the population today, not just regarding global

warming but also regarding all the health benefits following a plant-based diet.

This exploratory study was performed in three different counties of Latin

America, selected for their position on the geography of the continent, their

position on the map allow us to have a global view of Latin American countries

from north to south, and from interior land and coast. In addition, the study was

performed with collaboration of well positioned universities in each country and

for further participants also was used social media. This is a pioneer study from

consumers across Latin America therefore the findings can be used as platform

for other studies to increase the research on PBD and climate change.

28

Research question

How ready are consumers in Latin American countries towards adopting a plant-

based diet?

• Which is the role of the awareness, knowledge and frequency of

consumption towards the willingness to adopt a plant-based diet

associated to socio demographic characteristics?

• Which are the main barriers and facilitators responsible for move towards

a plant-based diet in Latin-American countries

• Which are the reasons involved for considering whether or not to change

the diet?

• Which are the reasons involved for considering whether or not to change

the diet on family parents?

Study design

Data collection A quantitative consumer survey was carried out through the online

program surveyXact and distributed among selected Latin American countries.

The survey was pretested in order to check the layout and gain an understanding

of it. The questionnaire was developed in Spanish and Portuguese (the native

language).

Data was collected in university classrooms via social media and online

services with the help of collaborators in Bolivia, Brazil, and Chile. The selected

sampling method was a non-probability snowball sampling. The inclusion criteria

were defined by 15 to 99-year-old residents of selected countries. The results

from the survey were exported to Excel for further analysis, and segmentation

was conducted using the R and Rstudio® software.

29

Questionnaire The survey was elaborated in Spanish and Portuguese. An unofficial

English translation of the questionnaire is enclosed in Appendix Nº1. The average

time to answer is 5–10 mins and consists of 16 questions. At the beginning of the

questionnaire, the definition of a plant-based diet is given:

“a plant-based diet is a diet that includes mostly fruits,

vegetables, legumes, and cereals, ideally food minimally

processed. Low amount or no presence of food form animal

sources (meat, chicken, pork, fish, dairy, or eggs)” (Garton

& Hood, 2017; Ostfeld, 2017)

The first part of the questionnaire focused on the sociodemographic

aspects of the respondent, such as country (Bolivia, Brazil, or Chile), gender

(female or male), age (y), education level (elementary, secondary, or superior),

residential area (rural, semi-urban, or urban), household members, and presence

of children in the household.

The second part of the survey started off with the type of diet, the

frequency of consumption for different types of food groups, one question about

knowledge, one question about awareness, and one question on barriers and

facilitators to follow a plant-based diet.

The third and last part of the questionnaire comprised the dependent

variables of the research question asking about the willingness and the intention

to change to a plant-based diet considering health and environment care, and

one question was based only for parents regarding the intention to change the

thinking of their children and improve the health of the whole family and the

environment for the future of their kids.

30

Data analysis After gathering all the respondents, the data was exported to Excel,

cleansed and made suitable for data analysis using the R and Rstudio® software.

The data erased surveys that were incomplete and did not meet the

inclusion criteria. To make the database suitable for analysis, recodes were

incorporated into the answers, granting the knowledge questions based on

whether they were correct or not to perform a knowledge score. The frequency

questions were assigned a score according to the chosen frequency to obtain an

average of the consumption.

First, descriptive statistics was applied: proportions and percentages were

used for categorical data, means, and standard deviations to describe continuous

symmetric data, and medians and IQRs for skewed data.

The respondents were analyzed by the countries Bolivia, Brazil, and Chile

and profiled using logistic regression models when the dependent variable was

dichotomic and linear regression when the independent variable was a scale.

The above mentioned two logistic regression models were fully adjusted

to the parameters of age, gender, educational level, residence, and type of diet.

For each analysis, an odds ratio (OR) and a confidence interval (CI) were

computed; also, the p-value, which is considered statistically significant when

lesser than 0.05, was calculated.

31

Results

Socio demographic description of the sample Table 4 shows the socio-demographic characteristics of the sample, which

consists of 827 respondents who completed the survey from three different Latin

American countries (Bolivia, Brazil, and Chile). As shown in Table 1, Chile was

found to be the country with the maximum number of respondents (N 322). The

mean age of the participants for Brazil and Chile was over 30 years and for Bolivia

lower than 22 years. Most of the respondents were female in all three countries,

and a majority of them had completed higher education. The largest number of

respondents resided in urban locations in all three countries. Regarding the type

of diet, the majority of the respondents defined themselves as omnivores (80%–

74%) followed by flexitarians (between 8% and 20%); and a very few declared

themselves to be vegans or vegetarians.

Table 4 Socio-demographic characteristics of the sample

Country Bolivia Brazil Chile

Res pondents N=245 N=260 N=322

A g e

Mean 22.39 31.64 36.6

SD 5.41 10.19 20.03

Gender

F 124 51% 211 81% 283 88%

M 121 49% 49 19% 39 12%

Education level

Basic 0 0% 0 0% 1 0%

Secondary 33 13% 12 5% 19 6%

technical 13 5% 5 2% 35 11%

Higher 199 81% 243 93% 267 83%

Res idence

Urban 173 71% 247 95% 292 91%

Semi urban 54 22% 9 3% 15 5%

Rural 18 7% 4 2% 15 5%

Diet

Flexitarian 21 9% 20 8% 66 20%

Omnivores 213 87% 193 74% 226 70%

Pescatarian 3 1% 8 3% 17 6%

Vegan 3 1% 9 3% 3 1%

Vegetarian 3 1% 29 11% 10 3%

Other 2 1% 1 1% 0 0%

32

Willingness to move toward a plant-based diet Figure 2 shows the willingness of the participants to change their type of

diet toward a more plant-based one. There is a trend toward a greater willingness

to change, as most respondents rated their responses as a yes between 5 and 7

on the Likert scale.

Figure 2 Willingness to move towards a plant-based diet

7%6%

10%

19%

27%

12%

19%

5% 5% 5%

13%

24%

15%

33%

3%2%

7%

11%

26%

17%

33%

0%

5%

10%

15%

20%

25%

30%

35%

1 2 3 4 5 6 7

% O

F SU

BJEC

T

WILLIGNESS TO CHANGE ON LIKERT SCALE

QUESTION: You would like to change to a diet with fewer animal products and more plant-based in the short term for the benefit of the

environment and your health

Bolivia Brazil Chile

33

Frequency of consumption Table 5 shows the descriptive results of the frequency of consumption.

Red meat in Chile is consumed almost two days per week (mean 1.69 days per

week), Bolivia more than three days per week (mean 3.27 days per week), and

Brazil was in the middle with almost three days (mean 2.69 days per week).

Of all the types of fresh meat consulted, the least consumed was found to

be fish with less than one day per week in all countries.

On the other hand, with respect to fruits, Brazil and Chile were found to

consume fruits more than five days on average (mean BL 5.32; CL 5.33) while

Bolivia four days (mean 4.33). Regarding vegetables, the difference in

consumption between the three countries was found to be approximately one day

per week: Bolivia 4.94 days per week, Brazil 5.58 days per week, and Chile 6.25

days per week, these differences were highly significant (p <0,0001).

Table 5 Frequency of consumption descriptive

*Superscript 1, 2, 3 indicate significantly difference between groups, in order from the most significantly difference (1) to the least significantly difference (3), following Anova F-test with post-hoc Bonferroni factor of correction.

Bolivia Brazil Chile ANOVA

Mean SD Mean SD Mean SD p-value Red meat 3 3.27 1.67 2 2.69 2.10 1 1.69 1.36 <0.0001 White meats 2 3.05 1.60 2 2.33 1.65 1 1.95 1.22 <0.0001 fish 2 0.67 0.83 3 0.66 0.83 1 0.93 0.83 <0.0001 Sausages 1 1.26 1.41 0.19 0.36 2 1.25 1.78 <0.0001

Dairy products 1

3.58 2.30 4.57 2.44 2 4.25 2.53 <0.0001 Eggs 3.07 1.89 3.35 2.17 3.28 1.85 0.233 Fruits 2 4.33 2.04 5.32 2.13 1 5.33 2.06 <0.0001 Vegetables 2 4.94 1.99 3 5.68 1.82 1 6.25 1.28 <0.0001 Legumes 3.34 2.20 5.13 2.08 1.47 1.08 <0.0001

Nuts and seeds 3

1.93 1.86 2 2.42 2.28 1 2.84 2.33 <0.0001

Cereals (rice and pasta)

2

4.72 2.11 1 5.65 2.11 3 3.52 1.94 <0.0001

34

Willingness to move towards a PBD influenced by frequency of consumption

Table 6 displays an overview of the willingness to move towards a plant-

based diet influenced by the frequency of consumption of certain food groups. It

shows foods that positively affect the willingness to move towards a PBD and

others that affect negatively.

On the negative side, it has clearly been shown that a high level of

consumption of animal products decreases the will to change to a plant-based

diet (red meat, white meat, fish, sausages, dairy products, and eggs) while, on

the positive side, consumption of plant-based foods such as fruits vegetables,

legumes, nuts, and seeds and cereals increases the will to change.

For example, Table 6 shows that in Chile, for each day of increase in red

meat consumption, the subject is significantly less willing to change their diet by

-0.26 (p 0.0002) point on Likert scale. Likewise, in Brazil, for each day of increase

in legume consumption, the subject is significantly more willing to change to a

plant-based diet by 0.17 (p <0.0001) point on the Likert scale (willingness from

1–7)

Table 6 Willingness to move towards a PBD influenced by frequency of consumption of certain groups of food

* Linear regression model adjusted by age, gender, education level, residence and diet *W: willingness to change. Correspondent to the Bcoefficient of the change

Bolivia Bra zil Chile

W 95% CI p-value W 95% CI p-value W 95% CI p-value

Red meat -0.06 -0.19 0.07 0.38 -0.12 -0.25 0.00 0.04 -0.26 -0.40 -0.13 0.0002

White meats 0.00 -0.14 0.13 0.96 0.06 -0.10 0.22 0.44 -0.03 -0.19 0.12 0.68

fish 0.10 -0.35 0.15 0.42 0.01 -0.25 0.27 0.94 -0.03 -0.17 0.23 0.74

Sausages 0.03 -0.12 0.18 0.66 -0.34 -0.94 0.25 0.26 0.05 -0.15 0.04 0.29

Dairy products

0.02 -0.07 0.12 0.61 -0.04 -0.13 0.05 0.37 -0.04 -0.11 0.03 0.22

Eggs -0.04 -0.15 0.08 0.53 0.06 0.03 0.16 0.19 -0.03 -0.12 0.06 0.49

Fruits 0.07 -0.03 0.18 0.16 0.15 0.05 0.25 0.002 0.03 -0.05 0.11 0.45

Vegetables 0.01 -0.01 0.20 0.07 0.23 0.12 0.35 <0,0001 0.05 -0.08 0.18 0.44

Legumes 0.02 -0.08 0.12 0.67 0.17 0.08 0.26 0.001 0.13 -0.04 0.29 0.13

Nuts and seeds

0.08 -0.03 0.20 0.15 0.15 0.06 0.24 0.002 0.02 -0.05 0.09 0.63

Cereals (rice and pasta)

-0.05 -0.15 0.05 0.35 0.00 -0.09 0.10 0.95 0.02 -0.06 0.11 0.59

35

Willingness to move towards a PBD influenced by knowledge First, the knowledge score of each country was obtained to have a sharper

picture of the knowledge of each country. The results show that Chile achieved

the highest score with an average of 6.84 points out of 9 questions (SD 1.89)

followed by Brazil with an average of 6.57 (SD 1.57) and Bolivia with an average

of 5.56 (SD 1.88).

Table 7 shows the willingness to move toward a plant-based diet

influenced by knowledge of specific statements. The table is organized to show

the true and false statements and analyzed the willingness to change the diet

based on the influence of the knowledge. The analysis shows that for each

correct answer, whether true or false, the willingness to change increased on the

Likert scale (willingness from 1–7). For example, according to the statement “PBD

can be beneficial for health”, in Bolivia, there is almost one point of increase on

Likert scale of willingness if the answered was correct (p 0.001) and more than

one point of increase on the willingness for Chile on the same question (W 1.52;

p < 0.0001).

36

Table 7 Willingness to move towards a PBD influenced by knowledge of specific statements


B o l ivia B razil C h ile


True Statement

Relation between Global warming and meat consumption

0.46 -0.07 0.99 0.091 0.46 0.07 0.98 0.0002 0.23 -0.14 0.61 0.223

Modification of the diet and fighting GW

0.15 -0.28 0.57 0.506 0.02 -0.52 0.47 0.925 0.41 0.05 0.78 0.027

PBD can be beneficial for health

0.96 0.40 1.52 0.001 1.40 0.63 2.17 0.0004 1.52 1.01 2.02 <0.0001

PBD Can prevent cancer

0.65 0.20 1.09 0.005 0.79 0.31 1.28 0.001 0.75 0.38 1.12 <0.0001

PBD can prevent diabetes & Hta

0.59 0.12 1.06 0.015 1.15 0.52 1.79 0.0004 1.02 0.58 1.47 <0.0001

False Statement

GW is an invention of the industry

0.05 -0.47 0.57 0.847 0.31 0.82 1.45 0.590 -1.66 -3.10 -0.23 0.024

PBD can cause malnutrition

0.85 0.43 1.26 <0.0001 0.82 0.33 1.30 0.0009 0.88 0.56 1.20 <0.0001

PBD can affect the immune system

0.71 0.29 1.13 0.001 0.77 0.40 1.15 <0.0001

PBD is hard to follow for children and elderly

0.41 -0.05 0.88 0.083 0.97 0.57 1.37 <0.0001 0.86 0.55 1.18 <0.0001

37

Willingness to move towards a PBD influenced by awareness regarding GW and PBD

Table 8 displays the willingness to move toward a plant-based diet

influenced by the awareness of the respondents according to a series of

statements related to global warming, plant-based diet, and health.

For instance, as shown in the table 8, an increase in agreement on the

“effect of the meat industry on GW” by one point on the Likert scale implies an

increase in the willingness to change significantly by 0.24 point (p 0.001) in Chile.

An increase in the agreement on the statement “following a PBD can lead to a

protein deficiency” by a point on the Likert scale resulted in a decrease in the

willingness to change diet by -0.24 points (p 0.001) in Bolivia.

Table 8 Willingness to move towards a PBD influenced by awareness regarding GW and PBD




The effect of the meat industry on GW

0.24 0.10 0.38 0.001 0.19 0.02 0.37 0.027 0.24 0.10 0.38 0.001

Use of water for producing meat products

0.15 0.01 0.29 0.043 0.42 0.22 0.63 <0,0001 0.15 0.01 0.29 0.043

WG can be fight with a PBD

0.25 0.11 0.39 0.001 0.24 0.09 0.39 0.002 0.25 0.11 0.39 0.001

Mediterranean diet can be beneficial for health and environment

0.28 0.13 0.43 0.0004 0.19 0.01 0.37 0.040 0.28 0.13 0.43 0.0004

PBD can treat chronic noncommunicable diseases

0.19 0.05 0.34 0.008 0.36 0.22 0.50 <0,0001 0.19 0.05 0.34 0.008

Following a PBD can lead to a protein deficiency

-0.24 -0.37 -0.11 0.001 -0.30 -0.41 -0.18 <0,0001 -0.24 -0.37 -0.11 0.001

38

Barriers and facilitators Table 9 show the descriptive analysis of the barriers and facilitators for

change to a plant-based diet. The table is organized to show the barriers and

facilitators and the average degree of agreement of the participants of each

country (1 to 7 on Likert scale).

P-value was calculated with Anova test to see if the differences were

significant between countries and, as is show on the table the differences

between Bolivia and Chile were more significant.

Regarding the barriers the participants state that they are not very much

in agreement in the statement “It is difficult to cook plant-based products (natural

or processed)” showing in the three countries a level of agreement under the 4

points. In contrast to this when is showed the statement “It's good for the

environment to eat plant – based” the level agreement on all the countries was

over the 4 points being closer of the 5 and 6 point on average.

39

Table 9 Barriers and facilitators descriptive analysis

*Superscript 1, 2, 3 indicate significantly difference between groups, in order from the most significantly difference (1) to the least significantly difference (3), following Anova F-test with post-hoc Bonferroni factor of correction.

Bolivia Brazil Chile ANOVA

Mean SD 95% CI Mean SD 95% CI Mean SD 95% CI p-value

Ba rriers It is difficult to cook plant-based products (natural or processed)

1 3.56 1.40 3.38 3.73 2.64 1.56 2.45 2.83 2 2.84 1.45 2.68 3.00 <0.0001

Plant-based food is boring

1 3.65 1.45 3.47 3.83 2.67 1.62 2.47 2.87 2 2.82 1.46 2.66 2.98 <0.0001

It is more expensive to eat plant-based

1 4.20 1.63 4.00 4.41 3 3.37 1.85 3.14 3.59 2 3.91 1.77 3.72 4.10 <0.0001

It is difficult to find plant-based products in the supermarket

1 4.08 1.55 3.88 4.27 3.62 1.93 3.38 3.85 2 3.85 1.72 3.66 4.04 0.013

It's hard to eat plant-based at social gatherings

4.52 1.57 4.32 4.71 4.38 1.78 4.16 4.60 4.60 1.67 4.42 4.79 0.282

It is difficult to eat plant -based with children in the house

1 4.22 1.54 4.03 4.41 3 3.23 1.70 3.02 3.44 2 3.66 1.60 3.48 3.83 <0.0001

F a cilitators

Plant-based food is tasty

2 4.48 1.39 4.31 4.66 5.23 1.50 5.04 5.41 1 5.41 1.37 5.26 5.56 <0.0001

It's healthier to have a plant-based diet

1 4.63 1.47 4.44 4.81 5.23 1.53 5.04 5.42 2 5.12 1.34 4.97 5.27 <0.0001

It's good for the environment to eat plant – based

2 4.38 1.38 4.20 4.55 5.29 1.41 5.12 5.46 1 5.25 1.32 5.11 5.40 <0.0001

40

Intention to change diet influence by barriers and facilitator Table 10 displays the likelihood of the respondent to change to a plant-

based diet influenced by barriers and facilitators.

As is shown in the table, the barriers present less likely change diet. For

example, a respondent from Bolivia who believed that plant-based food is boring,

was 28% less likely to change diet (p 0.002), similar number in Chile (31%,

p 0.0001).

In contrast to that, the facilitators are more likely to change diet, the

respondents who believed that is healthier to have a plant-based diet increase

their probabilities to change to a plant-based diet. In Bolivia the likelihood was

106% (p < 0.0001), Brazil 64% (p < 0.0001) and Chile 98% (p < 0.0001).

The respondent who think that “It is good for the environment to eat plant-

based” are significantly more likely to change diet in all three countries Bolivia

29% (p 0.002), Brazil 77% (p < 0.0001) and Chile 83% (p < 0.0001).

41

Table 10 Intention to change diet influence by barriers and facilitator

* Logistic regression model adjusted by age, gender, education level, residence and diet


OR 95% CI p-value OR 95% CI p-value OR 95% CI p-value

B arriers to adopt a P B D

It is difficult to cook plant-based products (natural or processed)

0.91 0.74 1.11 0.35 0.80 0.66 1.04 0.019 0.90 0.76 1.06 0.20


0.72 0.58 0.88 0.002 0.97 0.63 0.91 0.0043 0.69 0.57 0.83 0.0001


0.93 0.78 1.10 0.38 0.87 0.74 1.02 0.089 0.91 0.79 1.04 0.16


0.97 0.81 1.17 0.77 0.99 0.85 1.14 0.85 0.97 0.84 1.11 0.64


0.96 0.80 1.15 0.64 0.87 0.73 1.03 0.106 0.90 0.78 1.05 0.18


0.95 0.79 1.14 0.56 0.76 0.63 0.91 0.003 0.78 0.66 0.91 0.0021

Facilitators to adopt a P B D


1.66 0.02 1.17 <0.0001 1.28 1.05 1.58 0.018 1.57 1.29 1.92 <0.0001


2.06 1.61 2.72 <0.0001 1.64 1.32 2.09 <0.0001 1.98 1.59 2.51 <0.0001

It's good for the environment to eat plant - based

1.29 1.05 1.62 0.0201 1.77 1.38 2.32 <0.0001 1.84 1.49 2.30 <0.0001

42

Willingness to change diet influence by barriers and facilitator Table 11 Shows the willingness of the respondents to change diet,

influenced by barriers and facilitators (1 to 7 on a Likert scale).

As is shown in the table, be on agreement by 1 point on Likert scale with

the statement “plant-based food is boring” leads to be significantly less willing to

move towards a plant-based diet in all three countries, Bolivia -0.27 points

(p 0.0002), Brazil -0.24 points (p 0.0003), Chile -0.34 points (p <0.0001).

When it presented the results of the facilitators to follow a diet based on

plants, it becomes evident that these increase the willingness of the respondents

to change their diet. This means that for each point in favour, on a Likert scale,

the respondents are with the specific statement, they increase the will to change.

In the case of the three statements, the results in all the countries studied are

significant (p < 0.0001).

The respondents who agreed on Likert scale with the sentence “Plant-

based food is tasty” in Bolivia were 0.52 more likely to change, in Brazil by 0.38,

and in Chile by 0.32. Regarding the statement “It is healthier to have a plant-

based diet” Bolivia was 0.59 more likely to change, Brazil by 0.36 and Chile 0.41.

And as is shown in the table the statement “It is good for the environment to eat

plant-based” had similar values and were all significant.

43

Table 11 Willingness to change diet influence by barriers and facilitator

*W.T.C willingness to change * Graduated on a 7-point Likert scale * Linear regression model adjusted by age, gender, education level, residence and diet


Change in WTC 95% CI p-value



B arriers to adopt a PBD


-0.06 -0.21 0.01 0.435 -0.23 -0.36 -0.11 0.0004 -0.13 -0.24 -0.01 0.029


-0.27 -0.42 -0.13 0.0002 -0.24 -0.37 -0.11 0.0003 -0.34 -0.45 -0.22 <0.0001


0.05 -0.18 0.08 0.492 -0.20 -0.31 -0.09 0.001 -0.06 -0.16 0.03 0.184


0.01 -0.13 0.15 0.890 -0.09 -0.19 0.01 0.09 0.01 -0.09 0.10 0.903


0.03 -0.16 0.10 0.646 -0.11 -0.22 0.005 0.06 -0.07 -0.17 0.03 0.181


-0.10 -0.24 0.04 0.175 -0.24 -0.36 -0.12 <0.0001 -0.14 -0.25 -0.04 0.006

Fac ilitators to adopt a P B D

Plant-based food is tasty 0.52 0.38 0.66 <0.0001 0.38 0.25 0.52 <0.0001 0.32 0.20 0.44 <0.0001


0.59 0.46 0.72 <0.0001 0.36 0.22 0.49 <0.0001 0.41 0.29 0.53 <0.0001


0.38 0.23 0.53 <0.0001 0.34 0.19 0.49 <0.0001 0.36 0.24 0.49 <0.0001

44

Barriers and facilitators influence by diet Table 12 shows the reduction of agreement, on the Likert scale, influenced

by the diet of the respondents, taking as reference the omnivorous diet.

As it is possible to see on the table, with respect to the barriers, in the

majority is presented a reduction in the agreement and regarding the facilitators,

a greater agreement with the statements is presented by the respondents.

As is displayed in Table 12 part 1, vegans from Chile were less 2.01 points

on Likert scale (p 0.016) than omnivorous with the statement “It is difficult to cook

plant-based products (natural or processed)”. On another example, flexitarians

from Brazil were –1.30 points less agreement with the statement “It's hard to eat

plant-based at social gatherings” (p 0.002).

Table 12 part 2 shows the facilitators to change to a PBD, and vegetarians

from Chile and Brazil were more than 1 point according to the statement “It's good

for the environment to eat plant-based” (p < 0.0001) in comparison to the

omnivores.

45

Table 12 Barriers and facilitators influenced by diet (part 1)


A 95% CI p-value A 95% CI p-value A 95% CI p-value

Barriers to adopt a PBD

It is difficult to cook plant-based products (natural

or processed)

Flex -0.07 -0.71 0.57 0.832 -0.27 -0.97 0.44 0.455 -0.36 -0.75 0.03 0.069

Ot 0.27 -1.72 2.37 0.788 0.57 -2.58 3.73 0.721

Pesc -1.31 -3.01 0.40 0.134 -0.56 -1.62 0.50 0.305 -1.07 -1.76 -0.37 0.003

Vegan -0.97 -2.60 0.66 0.245 -1.83 -2.87 -0.78 0.001 -2.01 -3.64 -0.38 0.016

Vegt 0.15 -1.47 1.77 0.857 -1.23 -1.83 -0.63 <0.0001 -1.29 -2.19 -0.39 0.005


Flex -0.34 -0.99 0.31 0.313 -0.83 -1.52 -0.13 0.020 -0.58 -0.94 -0.21 0.002

Ot -1.43 -3.47 0.60 0.169 -0.56 -3.68 2.56 0.725

Pesc -0.54 -2.28 1.20 0.546 -1.94 -2.99 -0.89 0.000 -1.72 -2.37 -1.07 <0.0001

Vegan -1.80 -3.46 -0.13 0.036 -1.81 -2.84 -0.77 0.001 -1.30 -2.83 0.22 0.095

Vegt -0.91 -2.57 0.74 0.282 -1.53 -2.13 -0.94 <0.0001 -1.76 -2.60 -0.92 <0.0001

It is more expensive to eat

plant-based

Flex -0.92 -1.64 -0.19 0.014 -0.34 -1.17 0.48 0.415 -0.64 -1.12 -0.17 0.009

Ot -0.73 -3.01 1.54 0.527 -3.70 -7.41 0.01 0.052

Pesc -2.21 -4.16 -0.27 0.027 -0.79 -2.04 0.45 0.213 -0.59 -1.45 0.27 0.179

Vegan -0.85 -2.71 1.01 0.369 -1.59 -2.82 -0.36 0.012 0.68 -1.32 2.69 0.504

Vegt -0.82 -2.67 1.03 0.384 -1.52 -2.23 -0.82 <0.0001 -1.56 -2.66 -0.45 0.006

It is difficult to find plant-based products in the

supermarket

Flex -0.12 -0.81 0.57 0.738 -0.08 -1.00 0.83 0.857 0.18 -0.29 0.66 0.449

Ot -1.50 -3.66 0.67 0.176 1.66 -2.44 5.76 0.428

Pesc -0.87 -2.73 0.98 0.356 -0.45 -1.82 0.93 0.525 -0.05 -0.90 0.81 0.914

Vegan -0.02 -1.80 1.75 0.978 -0.88 -2.24 0.47 0.203 0.20 -1.80 2.20 0.848

Vegt -0.33 -2.09 1.43 0.717 -0.80 -1.58 -0.02 0.045 -0.59 -1.69 0.51 0.294

It's hard to eat plant-based at

social gatherings

Flex -0.76 -1.46 -0.06 0.034 -1.30 -2.11 -0.49 0.002 0.09 -0.36 0.54 0.697

Ot -2.05 -4.25 0.14 0.068 0.01 -3.63 3.65 0.996

Pesc -1.44 -3.32 0.44 0.134 -1.79 -3.01 -0.57 0.005 -0.28 -1.10 0.53 0.494

Vegan -1.13 -2.93 0.66 0.217 -0.70 -1.91 0.50 0.255 -1.94 -3.84 -0.04 0.457

Vegt -1.55 -3.33 0.24 0.090 -0.83 -1.53 -0.14 0.019 -0.58 -1.62 0.47 0.281

It is difficult to eat plant -based with children in

the house

Flex 0.10 -0.59 0.79 0.785 -0.25 -1.01 0.51 0.521 -0.29 -0.72 0.14 0.181

Ot -0.93 -3.09 1.23 0.401 -2.69 -6.09 0.71 0.122

Pesc 0.43 -1.42 2.28 0.649 -1.51 -2.66 -0.37 0.010 -1.12 -1.89 -0.35 0.000

Vegan -0.76 -2.52 1.01 0.404 -1.46 -2.59 -0.33 0.011 -1.81 -3.61 -0.02 0.048

Vegt -1.70 -3.46 0.06 0.060 -1.02 -1.67 -0.38 0.002 -1.57 -2.56 -0.58 0.002

*A: agreement on Likert scale. Correspondent to the Bcoefficient of the change *Reference omnivores *Flex= Flexitarians; Ot= Other; Pesc= Pescatarian; Vegt= Vegetarian *Linear regression model adjusted by age, gender, education level, residence and diet. * Graduated on a 7-point Likert scale

46

Table 12 Barriers and facilitators influenced by diet (part 2)

*A: agreement on Likert scale. Correspondent to the Bcoefficient of the change *Reference omnivores *Flex= Flexitarians; Ot= Other; Pesc= Pescatarian; Vegt= Vegetarian *Linear regression model adjusted by age, gender, education level, residence and diet. * Graduated on a 7-point Likert scale


A 95% CI p-value A 95% CI p-value A 95% CI p-value

Facilitators to ad opt a PBD


Flex -0.38 -0.99 0.24 0.231 0.34 -0.24 1.03 0.226 0.60 0.24 0.96 0.001

Ot -1.88 -3.81 0.05 0.057 0.58 -2.29 3.44 0.693

Pesc -0.83 -2.49 0.82 0.323 1.64 0.68 2.60 0.001 1.00 0.36 1.64 0.003

Vegan -0.22 -1.80 1.36 0.783 1.82 0.88 2.77 0.000 1.76 0.26 3.26 0.022

Vegt 0.81 -0.76 2.38 0.314 1.49 0.95 2.04 <0.0001 1.34 0.51 2.17 0.002

It's healthier to have a plant-

based diet

Flex -0.25 -0.89 0.40 0.454 1.08 0.44 1.72 0.001 0.61 0.25 0.96 0.001

Ot -2.07 -4.09 -0.06 0.045 2.36 -0.50 5.23 0.107

Pesc -1.44 -3.17 0.28 0.102 0.88 -0.08 1.84 0.074 1.09 0.45 1.73 0.001

Vegan 0.48 -1.18 2.13 0.573 2.22 1.27 3.17 <0.0001 1.30 -0.19 2.79 0.088

Vegt 0.09 -1.55 1.73 0.916 1.37 0.83 1.92 <0.0001 1.45 0.63 2.27 0.001

It's good for the

environment to eat plant -

based

Flex -0.20 -0.80 0.41 0.524 0.68 0.08 1.28 0.028 0.48 0.14 0.82 0.005

Ot -0.08 -1.97 1.80 0.930 -0.06 -2.74 2.63 0.967

Pesc -0.34 -1.96 1.27 0.676 0.77 -0.13 1.67 0.096 1.21 0.60 1.81 0.0001

Vegan -0.13 -1.68 1.41 0.865 2.06 1.17 2.95 <0,0001 1.92 0.51 3.33 0.008

Vegt -0.17 -1.71 1.36 0.827 1.25 0.74 1.76 <0.0001 1.64 0.87 2.42 <0.0001

47

Intention to change diet and motives As of the last set of questions on the survey, participants were consulted

for the intention of changing diet for a more plant-based one and their intentions

to answer yes or no, Figures 2, 3 and 4 show these results.

Figure 3 shows how many participants were considered to change, as is

evident in all three countries that the majority of participants had thought about

changing.

Figure 3 Intention to change to a PBD

62%

69%

63%

38%

31%

37%

0%

10%

20%

30%

40%

50%

60%

70%

80%


% O

F SU

BJEC

TS

QUESTION: Have you considered to change your current diet towards a plant based diet

Yes No

48

Figure 4 displays the motives of the participant to think on change diet,

and in all countries, more than 50% state that improves health was a motive, also

the quality of life was very important. On the less voted was animal respect on

Bolivia and Chile but in Brazil, more than 50% selected this statement.

Figure 4 Motives to change to a PBD

54%48%

20%16%

50%

65%

42%

54%51%

68%

32%

24%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Improve your health Improve the quality of l ife Improve the environment Animal respect

% O

F SU

BJEC

TS

Motives for change to a plant based diet


49

Figure 5 shows those respondents who had not considered changing their

diet for a more plant-based and the reasons for their response. Most of them

(over 50% in all three countries) said that they did not intend to change their

current diet, followed by it is very difficult to make the change (between 30 and

57%) and finally the minority answered that they were already following a diet

based on plants (2 to 12%).

Figure 5 Motives to NOT change to a PBD

2%

52%57%

9%

65%

30%

12%

51%

41%

0%

10%

20%

30%

40%

50%

60%

70%

I´m al ready follow a plant-baseddiet

I’m not interest on changing my current diet

Is too hard to change

% O

F SU

BJEC

TS

Motives for NOT change to a plant based diet


50

Intention to change diet and motives for parents

This section reports results for the subgroup of respondents who answered

that they had children at the beginning of the questionnaire were asked if they

had thought about changing their diet and that of their families for one more based

on plants and the reasons for their response, whether positive or negative.

Figure 6 shows how many participants with children were considered to

change his, and their family’s diet, as is clearly showed Bolivia had more parents

who had thought on change. However, the numbers in the other countries were

quite similar.

Figure 6 Intention to change to a PBD for parents

63%

42%

52%

36%

57%

47%

0%

10%

20%

30%

40%

50%

60%

70%


% O

F SU

BJEC

TS

QUESTION: Since the birth of her children had you considered changing your diet and that of your family, for

one based on plants

Yes No

51

Figure 7 express the motives for change diet of the family and in all three

countries improve health and quality of life was the most selected by participants,

also for the participants in Brazil was important the preservation of the

environment and the respect for the living beings on the planet.

Figure 7 Motives to change to a PBD for parents

57%

64%

14% 14%

68%65%

55%

42%

52%

77%

23%

15%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Improve your health and yourfamily

Improve the quality of l ife ofthe hole family

Preserve the environment inwhich my children will grow

Respect for the living beings ofthe earth

% OF

SUBJ

ECTS

Motives to parents for change to a plant based diet


52

Figure 8 shows those parents who had not considered changing their diet

for a more plant-based and the reasons for their response. most of them (over

50% in all three countries) said that they did not intend to change their current

diet, followed by it is very difficult to make the change, and finally, the minority

answered that they were already made the change for all their family.

Figure 8 Motives to NOT change to a PBD for parents

13%

50% 50%

24%

57%

24%

6%

52%

42%

0%

10%

20%

30%

40%

50%

60%

We already made the diet change mywhole family

I'm not interested in changing the currentdiet we have

It is very di fficult to change diet.

Motives to parents for NOT change to a plant based diet


53

Discussion The following discussion will evaluate the implications and impacts of the

above-mentioned results in relation to the research question and findings from

other studies, and some limitation observed during the development of this thesis.

The sample To begin, it is necessary to place it in the reality of each country in order

to understand the sociodemographic differences or similarities of the sample,

Bolivia has a population of 11.216.000 of which 50.1% are women and 49.3%

are men according to the data processed by the household survey 2017. The

58.4% of the population is between 15 and 59 years old (www.ine.gob.bl). Chile

has a population of 18.729.160 of which 49.3% are men and 50.7% are women.

The 68,7% of the population is between 15 and 64 years old (www.ine.cl). Brazil

has a population of 207.999.646, it is important to mention that just the

metropolitan region of São Paulo has more population than Bolivia and Chile with

19.509.000 people. 69,16% of the population is between 15 and 59 years old and

49,1% were men and 50,8% were women according to the data processed by

the statistical institute of Brazil (www.ibge.gov.br).

The sample had certain differences that could explain some results later.

The mean age for Bolivia was 22.4 years old, Brazil 31.6 years old and Chile 36.6

years old. Bolivia particularly has a lower range of age. This difference could

affect the level of knowledge, awareness and the frequency of consumption of

certain groups of food. Since the respondents of Bolivia are mostly referred to as

the z generation, since they have had most of their lives access to computers

with internet, which allows them to be more informed and more aware of the

problems that affect the world and not only to your country (K. C. Williams & Page,

2011). On the other hand, in Brazil and Chile they can be considered as first

generation millennials since they exceed 30 years old , this group of individuals

have already started working and forming families, which traditionally leads them

to be more aware of their health and the environment that surrounds them, but

not always the globalized world in which we live today (K. C. Williams & Page,

2011).

The sample In Brazil and Chile is led by women with a large difference,

contrary to Bolivia which is mostly even between women and men. This difference

54

can generate a bias in the results as it is shown in some studies that is socially

associated with women lower consumption of red meat and higher consumption

of vegetables and fruits (Orellana et al., 2013). Also, Women are more aware of

the impact of the meat industry on the environment therefore they change more

their diet than men (Sanchez-Sabate & Sabaté, 2019).

The educational level of most of the participants was higher education

level (over 80% in all three countries) and this has a significant correlation with a

healthier diet, a lower body weight and higher concern for organic products and

the environment (Lê et al., 2013) this aspect of the sample could affect the results

regarding reasons of knowledge, awareness, and willingness to change diet, this

may not be representative for all sectors of the population.

Willingness to Move Toward a Plant-based Diet As is presented in the results, most of the sample in all three countries

were willing to change diet for a more plant-based one, based on health benefits

and environmental aspects. Is well documented the correlation between the high

consumption of animal products and type two diabetes, cancer and heart

diseases (Raphaely & Marinova, 2014; Pino et al., 2009; Rojas et al., 2017;

Melina et al., 2016). In relation to the environmental aspects, we can say that

Over the last decade awareness of the impact of the food industry have become

more transparent to population. The food industry is responsible for between 18-

31% of the greenhouse emissions (Patterson et al., 2019) and the animal

husbandry sector by itself is responsible for the 18% (Steinfeld et al., 2009) in

contrast to that plant-based diets are proved to be more environmental friendly

due the use of fewer natural resources (Melina, Craig, & Levin, 2016). therefore,

it makes sense that well-educated people are aware of these warnings and wish

to make a change in their diets to improve or maintain their health and have a

lesser impact on global warming. However, as we can see on the

sociodemographic results of the sample the most of them recognizes itself as

omnivorous or flexitarians. Studies had found that there is a group of consumers

that are not ready to give up meat but who are willing to reduce or change their

meat consumption (Sanchez-Sabate & Sabaté, 2019). This give us an idea that

even though they want to change there is something that prevents or retains them

in traditional diets, this could be explained by two sources , the first one is on the

55

European population that still maintain the main source of proteins on diets from

meat (Davis et al., 2010) and in western countries meat, maintain his position as

a key ingredient for healthy and balanced diets as the central position in meals

and social relationships (Niva et al., 2017).

Frequency of Consumption In relation to the frequency of consumption of different groups of foods,

the average consumption is very close to the dietary recommendations of each

country being red and white meat more consumed than fish, fruits and vegetables

with a high average consumption and Cereals and pasta consumed more than

half of the week Willingness to move towards a PBD influenced by frequency of

consumption (source :OMS /OPS www.paho.org).

The willingness to move towards a plant-based diet is influence negatively

or positively by the frequency of consumption. On the side of the negative

influence we can find all the animal products as meat, sausages, dairy products,

and eggs, this could be explained by the position of the animal products on the

idea of a healthy and balanced diet and as a central ingredient for meals and the

primary source of proteins (Davis et al., 2010) (Niva et al., 2017).

Willingness to Move Toward a PBD Influenced by Knowledge and Awareness Regarding GW and PBD

A closer examination regarding the knowledge of the participants and the

relation of that with the willingness to move towards a plant-based diet makes

clear that more knowledge gives the individual significantly more will to change

to a plant-based diet.

In relation to the awareness of the participants about the global warming

and how plant-based diet can fight this issue is evident on the results that the

more awareness exists a significant difference on the will to change on all three

countries. Willingness to reduce meat consumption is influenced by cultural and

social values and is highly related to habits and routines (Austgulen et al., 2018)

and some studies had found that women are more aware of the impact of the

meat industry on the environment and therefore they are more willing to change

than men (Sanchez-Sabate & Sabaté, 2019). This correlation between

knowledge, awareness and will to change is used to create public policies among

56

the developing countries, one example is Sweden how have been included in

their dietary guidelines environmental sustainability (Cleveland & Gee, 2017).

These results indicate that we can increase the knowledge and awareness

in the population on the topics of global warming, health, and plant-based diet to

encourage the population to make changes in the diet, which would benefit both,

their health and the environment.

Barriers and Facilitators Similar to the result showed by the authors on Denmark (Reipurth et al,

2019) the respondents agreed mostly with the barriers and facilitators proposed

by the authors that we used for this study.

The main barriers identified which can affect the willingness to change to

APB were regarding taste and convenience. On the other hand, the main drivers

to adopting a PBD are related to taste for the participants, this is very similar to

the result obtain in demark (Reipurth et al, 2019) other studies confirm the

findings. In EEUU a study related to the attitudes and perceptions of PBD found

that the strongest perceived barriers to adopt a plant-based diet is the enjoyment

of eating meat and the frequency of consumption of meat (Corrin &

Papadopoulos, 2017).

The intention to change influenced by the barriers and facilitators shows

an association between the barriers and less likely to change. In the case of

considering that it is difficult to eat plant based on social gatherings the

participants had less intention of change, this takes relevance when we observe

that other authors also describe as a great barrier any change of diet the difficulty

of access to products, whether in the supermarkets, restaurants or any

convenience store(Niva et al., 2017; Lea, Crawford, & Worsley, 2006a).

In relation to the willingness to change influence by barriers and

facilitators, there is also an association between the option of the participants and

the will to change. Talking about the facilitators, exist a positive effect on the will

to change diet, the participants who agreed with the statement “Plant-based food

is tasty” in Bolivia where 0.52 more likely to change, in Brazil by 0.38 and in Chile

by 0.32. This could be explained by how the participants feel about the plant-

based diet and their attitudes towards this type of food (Rothgerber, 2017).

57

Intention to Change Diet and Motives As of last part of the survey, the participants were consulted about their

intention to change to a more plant-based diet and which were the motives for

their positive or negative answer being able to select more than one reason.

In this case the majority of respondents from all three countries said yes

to change diet (over 60% in all countries), this could be caused by the awareness

or the knowledge of the participants regarding health issues or environmental

reasons as was explained above, or just explained by the high educational level

of the sample that makes them more exposed to the information and globalization

(Lê et al., 2013; Vogel et al., 2017).

The main reasons for saying YES is to improve the quality of life and

health, and is proved that a plant-based diet is healthier than a western diet

(Melina et al., 2016) (Lea, Crawford, & Worsley, 2006b).

The principal reasons for saying NO is the lack of interest in changing,

associated to think that is too hard to change diet, this could be associated with

the barriers to adopting a plant-based diet and the perception of the respondents

about the change (Reipurth et al, 2019), also is important to mention the lack of

suitable campaign for make a change on the behaviour and the social

consciousness of the population (Verain, Sijtsema, Dagevos, & Antonides, 2017).

For the group of parents, the responses were mostly the same with a

tendency to change diet for the entire family and the reasons were almost the

same as for the other group, therefore we can say that it does not matter if you

are parent or not, the intention to move towards a plant-based diet exists.

However new generations of parents are more conscious about the influence of

their choices on their children, therefore they are consciously more plant based

foods at family meals and by consequence to their daily diet.(Foods, 2019).

58

Limitations and Strength This study is an exploratory consumer, supported by different universities

on each studied country study, therefore a limitation could be selection bias and

the result could not be representative of the population.

The differences in age between countries could be influenced by the

results given as a result of similar conclusions on Brazil and Chile and so different

in some analysis in Bolivia. Apparently also the economic differences between

countries also could affect the results, even though el three are developing

countries, the economic model is different in Bolivia compared to Chile and Brazil.

Is important to mention the educational level of all the sample, more than

80% in all countries was from a highly educated group of people, and this could

be unrepresentative of the entire population of Latin American countries, however

the sample was made by snowballing sampling to avoid this bias but the

respondents were similar between them.

The strength of this study, is indeed, the fact that is an exploratory study,

and that the subject is wildly studied among develop countries but not among

developing countries. The snowballing method for the sampling is a strength that

allow us to make an estimation for the sample size for future consumer studies.

59

Conclusion This exploratory study gave insight about the willingness to move towards

a plant-based diet in selected countries in Latin-America.

The findings follow the world trending about plant-based foods, saying that

more people are willing to change to a plant-based diet, taking in to consideration

aspects as health, global warming and sustainability, to start this transition.

Frequency of consumption of different groups of foods impacts

significantly the willingness to change to a more plant-based diet. Also,

knowledge and awareness of subject such as health, global warming and

sustainability generate significant differences in the willingness to change, the

more knowledge and awareness in these subjects, the more chances to change

to a plant-based diet.

The differences on the economic develop of the countries state a

difference between the willingness to change of the consumer, with a clear

tendency to have less willingness to change by respondents of Bolivia, country

how had less economic develop than their neighbours Brazil and Chile, how show

more willing and awareness.

The principal barriers to change to a plant-based diet found were related

to the “good taste of meat” and also meat consumption is associated with routine

and habits. This translated into simple words means that people are used to

eating meat since childhood and it is part of their daily routine. This is due the

food based dietary guidelines that governments give to the population that

normally are based on animal products as mainly source of proteins and healthy

food. This should put us think the need of a deeper change, for create a real

impact on the diet of the population, governments need to make changes on their

politics and develop a food based dietary guidelines (FBDGs) concentrate on

heath and sustainability objectives no matter what the industry of food says.

These findings can inspire further researches for the reasons of the

differences between countries, and find approaches to motivate the population,

the governments and the health care system to change their current diet

recommendations in benefit of the world environment and people’s health.

60

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APPENDICES Appendix Nº1

Survey (non-official translation) Thank you very much for participating in this study.

It will take you 5 to 10 minutes to complete the survey.

The objective of this study is to determine the reality of the Latin American community on plant-based diets.

All those over 15 years old are welcome to answer it.

Complete this survey participate in this study, as part of an investigation to perform the thesis of magister at the University of Copenhagen, Denmark. All the data delivered are anonymous.

As definition for this survey:

Diet based on plants, a diet that includes fruits and vegetables, legumes and cereals, ideally minimally processed foods. With very little or no presence of food of animal origin (fresh beef, pork, turkey, chicken, fish, dairy products and their derivatives)

Mediterranean diet, a diet with a higher intake of fruits, vegetables, legumes, olive oil as the main fat, fish, nuts, bread and other cereals as the basis of food, maintaining a low consumption of meat and its derivatives and products highly processed

1. Country of residencies o Argentina o Bolivia o Brazil o Chile o Ecuador o Paraguay o Perú o Uruguay

2. Age

Number: _________

3. Gender o F o M

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4. Educational level o Basic education o Secondary education o Superior technician o University education (bachelor's, master's, doctorate)

5. My permanent residence is in o Urban o Semi urban o Rural

6. How many people live with me (me included) n=______

7. There are children (under 12 years old) living with me

o Yes o No

8. Do you have kids o Yes o No

9. What is your type of diet currently

o Omnivore (consumes some type of product of animal origin, more than 3 days per week)

o Flexitarian (consumes some type of product of animal origin, less than 3 days per week)

o Pescatarian (does not consume meat or sausages, but fish and seafood)

o Vegetarian (does not consume meat products, but dairy products and eggs)

o Vegan (does not consume any type of products of animal origin)

o Other _____ (specify)

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10. Could you indicate how often you eat this product

1 o 2 times per month

1

day per week

2 days per week

3 days per week

4 days per week

5 days per week

6 days per week

7 days per week

Is not part of my diet

Red meats

White meats

fish

Sausages

Dairy products

Eggs

Fruits

Vegetables

Legumes

Nuts and seeds

Cereals such as rice and pasta

11. could you indicate that you think of these affirmations, they are true or false for you.

true False

The consumption of products of animal origin contributes to global warming x

Global warming is an invention of the industry to generate more sales x

Modifying the diet can generate a change in global warming x

Having a plant-based diet can be beneficial for my health x

A diet based on plants can cause problems of malnutrition x

A plant-based diet can prevent cancer x

A diet based on plants can weaken my immune system x

A plant-based diet can prevent and treat type 2 diabetes and high blood pressure x

A plant-based diet is harder for children and the elderly to follow because of their nutritional needs

x

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12. Could you indicate how much you agree or disagree with the following statements?

Totally disagree

Slightly disagree

Disagree Neither agree nor disagree

Agree Slightly agree

Totally agree

The effect of the meat industry on global warming is great

The use of water for the production of processed meats is very large

Global warming can be combated with a plant-based diet

A Mediterranean-type diet can be beneficial for the health of people and the environment

A plant-based diet can treat chronic noncommunicable diseases such as type 2 diabetes and high blood pressure

If I follow a plant-based diet I may have protein deficiency

13. Could you indicate how much you agree or disagree with these statements?

Totally disagree

Slightly disagree

Disagree Neither agree nor disagree

Agree Slightly agree

Totally agree










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14. You would like to change to a diet with fewer animal products and more plant-based in the short term for the benefit of the environment and your health

Where 1 is no intention and 7 is much intention

1 2 3 4 5 6 7

15. Have you considered to change your current diet towards a plant-based diet o Yes o No

Why? (yes)

o Improve your health o Improve the quality of life o Improve the environment o Animal respect

Why? (no)

o I´m already follow a plant-based diet o I’m not interest on changing my current diet o Is too hard to change

16. Since the birth of her children she has considered changing her diet and that of her family, for one based on plants

o Yes

o No

Why? (yes)

o Improve your health and your family o Improve the quality of life of the whole family o Preserve the environment in which my children will grow o Respect for the living beings of the earth

Why? (no)

o We already made the diet change my whole family o I'm not interested in changing the current diet we have o It is very difficult to change diet.

Comments __________________________________________________________________________________________________________________________________________________________________________________________________________

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Appendix nº2

Commands used in Rstudio for full adjusted model

#Q14 VS Q10 BR.Q14vsQ10.1 <- glm(Q14 ~ Q10.1 + Q2 + as.factor(Q3) + as.factor(Q4) + as.factor(Q5) + as.factor(Q9) , data = DATA.BR2.R.) # linear regression summary(BR.Q14vsQ10.1) confint(BR.Q14vsQ10.1) #Q14 VS Q11 BR.Q14vsQ11.1 <- glm(Q14 ~ Q11.1 + Q2 + as.factor(Q3) + as.factor(Q4) + as.factor(Q5) + as.factor(Q9) , data = DATA.BR2.R.) # linear regression summary(BR.Q14vsQ11.1) confint(BR.Q14vsQ11.1) #Q14 VS Q12 BR.Q14vsQ11.1 <- glm(Q14 ~ Q11.1 + Q2 + as.factor(Q3) + as.factor(Q4) + as.factor(Q5) + as.factor(Q9) , data = DATA.BR2.R.) # linear regression summary(BR.Q14vsQ11.1) confint(BR.Q14vsQ11.1) #Q15 VS Q13 BR.Q15vsQ13.1 <- glm(Q15 ~ Q13.1 + Q2 + as.factor(Q3) + as.factor(Q4) + as.factor(Q5) + as.factor(Q9), data = DATA.BR2.R., family = binomial) #Logistic regression summary(BR.Q15vsQ13.1) confint(BR.Q15vsQ13.1) exp(-0.10406) # odds ratio (OR) exp(c(-0.2935459 ,0.08192473)) # confidence interval for the OR #Q14 VS Q13 BR.Q14vsQ13.1<- glm(Q14 ~ Q13.1 + Q2 + as.factor(Q3) + as.factor(Q4) + as.factor(Q5) + as.factor(Q9), data = DATA.BR2.R.) # linear regression summary(BR.Q14vsQ13.1) confint(BR.Q14vsQ13.1) #Q13 VS Q9 BR.Q13.1vsQ9 <- glm(Q13.1 ~ relevel(Q9,"OMN ") + Q2 + as.factor(Q3) + as.factor(Q4) + as.factor(Q5), data = DATA.BR2.R.) # linear regression summary(BR.Q13.1vsQ9) confint(BR.Q13.1vsQ9) *BR is replaced for Bl and Cl to obtain all countries data

Documents

1. Final master Thesis ABR - repositorio.conicyt.cl