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Healthy eating attitudes and healthy living:
An examination of the relationship between attitudes,
food choices and lifestyle behaviours in a representative
sample of Irish adults
Dr. Paul Naughton, Teagasc
Dr. Sinéad McCarthy, Teagasc
Dr. Mary McCarthy, UCC
Overview
Dietary guidelines and health
Attitude and food choice
Methodology
Findings
Discussion
Conclusion and implications
Dietary guidelines and health
Dietary recommendations and actual consumption do not coincide
on a general population level (Irish Universities Nutrition Alliance (IUNA),
2011)
On average Irish adults are not meeting the minimum
recommendations for time spent at physical activity (IUNA, 2012)
Obesity is a global epidemic (WHO, 1998; OECD, 2010)
Excess calorie consumption and inactivity are the main causes of
obesity (NTFO, 2005; CEC, 2007)
Associated with an array of non-communicable diseases including CVD,
Hypertension and Type 2 diabetes
Since 1990 the prevalence of obesity in 18-65 year old Irish
adults has increased significantly (IUNA, 2011)
Attitudes
For marketers the study of consumer attitudes is one of the most
important means to understanding consumer behaviour
Attitudes influence, guide, shape and predict actual behaviour
Attitude
towards
health
Health
Motivation
Actual
Behaviour
Belief: Cost
Belief:
Sensory
Belief:
Health benefits
Strongly held attitudes are a good predictor of behaviour
Research aim
The objective of this study is to examine dietary, lifestyle and
activity behaviours across varying levels of attitudes towards
eating a healthy diet
To understand the importance of healthy eating attitudes in relation
to healthy eating behaviour among Irish adults
Any attempt to influence food choice via policy or NPD must be
evidence based, targeted and culturally appropriate
National Adult Nutrition Survey
Food Diary
4 day semi weighed
NANS
Dataset
(n=1500) Physical Activity
Questionnaire
Anthropometric
Data e.g. BMI
Biological Samples (Blood & Urine)
Lifestyle
Questionnaire
Food Choice Questionnaire
motivations, attitudes & beliefs regarding food All data for each individual
linked in a relational
database using unique ID
codes
Food Choice Questionnaire
Questions derived from previously validated scales
Adapted for an Irish setting & context
83 statements
Likert scale, 1 strongly disagree to 7 strongly agree
Food Diary
Measures the what, when and where
4 days – balance of week and weekend days
Semi-weighed
All information on every food consumed recorded
Time, Location, Preparation of meal snack, All constituents in the
meal/snack, Recipes
Identifying the healthy eating attitude groups
Healthy eating attitude statements Mean (SD)
It is important that the food I eat keeps me healthy 6.0 (1.1)
It is important that the food I eat is nutritious 6.1 (0.9)
It is important that the food I eat contains vitamin and minerals 5.6 (1.3)
It is important that the food I eat helps me control my weight 5.2 (1.5)
I always follow a healthy and balanced diet 4.4 (1.5)
I eat what I like and I do not worry about healthiness of food (R) 5.0 (1.6)
The healthiness of food has little impact on my food choices (R) 5.1 (1.5)
Composite healthy eating attitude 5.3 (0.9)
α = 0.808
Strongly
disagree
Disagree Somewhat
disagree
Neither
Somewhat
agree
Agree Strongly
agree
1 2 3 4 5 6 7
Tertiles of healthy eating attitude construct
Healthy Eating Attitude
Weak Moderate Strong
n 475 424 367
Mean (SD) 4.4 (0.7) 5.6 (0.2) 6.3 (0.3)
Min 2 5.2 6
Max 5.1 5.9 7
Strongly
disagree
Disagree Somewhat
disagree
Neither
Somewhat
agree
Agree Strongly
agree
1 2 3 4 5 6 7
Ranking of Food choice motives
Weak healthy
eating attitude
1. Taste
2. Convenience
3. Health & Nutrition
4. Cost
5. Weight control
Medium healthy
eating attitude
1. Taste
2. Health & Nutrition
3. Convenience
4. Cost
5. Weight control
Strong healthy
eating attitude
1. Health & Nutrition
2. Taste
3. Weight control
4. Cost
5. Convenience
Food consumption across tertile of healthy eating attitude
Weak healthy eating
attitude
Moderate healthy
eating attitude
Strong healthy eating
attitude
Mean SD Mean SD Mean SD
% contribution of fat to
energy 35.5 (6.3)*(a) 34.2 (5.9)*(b) 33.9 (6.2)*(b)
Food pyramid level 1
(gram/day) 84 (59)*(a) 71 (52)*(b) 68 (45)*(b)
Food pyramid level 2
232 (109) 224 (95) 226 (108)
Food pyramid level 3
260 (197) 291 (216) 279 (191)
Food pyramid level 4
197 (156)* 274 (178)* 339 (201)*
Food pyramid level 5
347 (149) 365 (156) 358 (141)
* Indicates statistical difference and abc subscripts denote significant differences within groups
Compliance with dietary guidelines
Complying with
recommendations
Population Weak healthy
eating attitude
Moderate
healthy eating
attitude
Strong
healthy eating
attitude
% % % %
Fat ≤ 35% of food energy 53 46 57 57
Fruit and veg consumption
400 g/d
21 11 23 31
Weak healthy eating
attitude
Moderate healthy
eating attitude
Strong healthy eating
attitude
Mean SD Mean SD Mean SD
Body Mass Index (BMI) 27.13 (5.1) 27.13 (5.1 26.43 (4.4)
Energy expenditure
through work MET hrs/wk 64.8 (61.6)*(a) 58.7 (61.5)*(a) 52.4 (56.5)*(b)
Watching television
hrs/week 21.7 (10.8)*(a) 18.8 (9.3)*(b) 17.7 (9.3)*(b)
Exercise
minutes/week 91 (195) 100 (172) 109 (135)
BMI and energy expenditure across tertile of healthy
eating attitude
* Indicates statistical difference and abc subscripts denote significant differences within groups
Socio-demographic profile across tertile of healthy
eating attitude 1
Population Weak healthy
eating attitude
Moderate healthy
eating attitude
Strong healthy
eating attitude
% % % %
Male 49.0 58.1 48.7 37.6
Female 51.0 41.9 51.3 62.4
18-35 years old 38.3 48.4 36.3 27.5
36-50 years old 30.2 28.0 31.8 31.1
51-64 years old 19.6 15.8 20.4 23.7
65+ 11.9 7.8 11.4 17.7
Single 34.4 43.1 33.0 24.6
Married 57.9 49.9 58.9 67.2
Widowed/Separated/div
orce 7.7 7.0 8.1 8.2
Socio-demographic profile across tertile of healthy
eating attitude 2
Population Weak healthy
eating attitude
Moderate healthy
eating attitude
Strong healthy
eating attitude
% % % %
Prof/Mang/Technical 45.7 39.0 50.9 54.7
Non manual skilled 18.7 20.5 17.5 17.6
Skilled manual 13.9 14.6 12.6 14.4
Semi-skilled/unskilled 20.0 25.9 19.0 13.3
Primary education 7.7 8.1 7.4 7.4
Intermediate 19.6 23.8 17 17.0
Secondary education 24.2 28.7 24.7 17.9
Tertiary 48.6 39.5 50.8 57.7
Demographic, consumption and energy expenditure
model to predict strong healthy attitude (1)
95% C.I. for Odds Ratio
B Sig. Odds Ratio Lower Upper
Gender (compared to men) 0.985 0.00 2.68 1.64 4.34
Age (18-35) 0.00
36-50 0.53 0.06 1.70 0.98 2.95
51-64 0.99 0.00 2.70 1.41 5.16
65+ 1.80 0.00 6.03 2.64 13.77
Social class 0.37
Marital status 0.20
BMI (Normal) 0.08
Overweight -0.14 0.53 0.88 0.56 1.34
Obese -0.57 0.05 0.56 0.34 0.94
Demographic, consumption and energy expenditure
model to predict strong healthy attitude (2)
95% C.I. for Odds
Ratio
One portion
(g/d) B Sig.
Odds
Ratio Lower Upper
% contribution of fat to
total energy - -0.03 0.05 0.97 0.94 1.00
FoodPyramid1
(Fats, sugary snacks) 30 -0.01 0.00 0.81 0.72 0.92
Foodpyramid2
(Meat, fish, eggs) - 0.00 0.21 1.00 1.00 1.00
Foodpyramid3
(Milk, cheese, yogurt) - 0.00 0.72 1.00 1.00 1.00
FoodPyramid4
(fruit and vegetables) 80 0.00 0.00 1.29 1.17 1.42
FoodPyramid5
(Bread, cereals, potatoes) - 0.00 0.11 1.00 1.00 1.00
Demographic, consumption and energy expenditure
model to predict strong healthy attitude (3)
95% C.I. for Odds Ratio
B Sig. Odds Ratio Lower Upper
Exercise < 26 min/week 0.05
Exercise 26-120 min/week (1) 0.34 0.16 1.41 0.87 2.25
Exercise > 120 min/week (2) 0.64 0.02 1.90 1.12 3.23
Work energy expenditure 0.85
Total TV watched in hrs/day -0.20 0.01 0.82 0.71 0.94
Discussion
Healthy eating attitudes are significantly and positively
associated with healthy eating behaviour (Roininen and Tuorila, 1999;
Roininen et al., 2001; Hearty et al., 2007)
Many studies have been limited by the precision of dietary assessment (Hearty et al., 2007)
FFQ <100 Items
Food Diaries > 3000 items
Healthy eating attitudes are associated with gender (Wardle et al.,
2004; NHF, 2005; Hearty et al.,2007) and age (Kearney et al., 1998; Hearty et al., 2007)
There was no relationship between healthy eating attitudes and social class
Positive attitudes towards healthy eating are positively associated with time spent at exercise (Hearty et al., 2007; Steptoe et al., 1997)
Conclusion and implications
Weak healthy eating attitude Attitude ambivalence: (taste &
convenience are equally important food choice considerations)
Optimistic bias
Target group
Emphasise the
consequences of
unhealthy lifestyle choices
NPD must consider these
issues
Male, younger adults
Strong healthy eating attitude Motivated by health & nutrition
Difficulty in meeting guidelines
Target group
Support through NPD and
focus on dietary control
Female, older adults
Acknowledgements
Department of Agriculture FIRM funding
NANS fieldwork team
Survey participants