Health and Social Behaviour: Social, behavioural and other determinants of the choice of diet
Diet choice is a complex area because there are a number of factors that affect the population’s and an individual’s choice of food. These have been divided into 6 key determinants:
- Biological determinants such as hunger, appetite, and taste
- Economic determinants such as cost and income
- Physical determinants such as access, education, skills and time
- Social determinants such as class, culture, and social context
- Psychological determinants such as mood, stress and guilt
- Attitudes, beliefs and knowledge about food.
1. Biological determinants such as hunger, appetite, and taste
Hunger and satiety
Humans need energy and nutrients in order to survive (see ‘Principles of nutrition’) and will respond to feelings of hunger and satiety. Different macronutrients have different effects on satiety. For example, fat is the
least satiating, followed by carbohydrates then protein. In addition, low energy density diets have greater satiety than high energy density (e.g. high fat and/or high sugar) diets.
Taste/Palatability
Palatability increases as the pleasure an individual experiences from eating a food increases. The taste, smell, texture and appearance of a food all impact on the palatability of a food. For example, sweet foods have a high sensory appeal and
have higher palatability meaning that the food may be consumed for pleasure rather than as a source of energy and nutrients. It is reported that the higher the palatability of a food, the higher the consumption.
There is some evidence so show that preferences for flavours can be acquired through breast milk as flavours from maternal diets pass into breast milk.
2. Economic determinants such as cost and income
Cost and income
The cost of food and the ability of an individual to afford specific foods (related to income) are primary determinants of food choice. Low-income groups are reported to consume unbalanced diets and low intakes of fruit and vegetables. Increasing
the amount of available income for food choices, however, does not necessarily mean that individuals will consume a more balanced and healthy diet. In addition, individuals may resist buying new foods for fear that the food made be wasted as the
family may reject the food.
3. Physical determinants such as access, education, skills and time
Accessibility and availability
Accessibility to shops and the availability of foods within shops influence food choice. This is associated with transport links and geographical locations. For example, ‘food deserts’ are areas of resistance with few or no shopping
facilities. Improving access does not necessarily mean that individuals will change their food choice.
Education and knowledge, and skills
Individuals that are educated and knowledgeable about ‘healthy eating’ are more likely to opt for healthy dietary choices. This, however, depends on whether the individual is able to apply their knowledge. Educating the population requires
accurate and consistent messages. Education on how to increase fruit and vegetable consumption in an affordable way such that no further expense, in money or effort, is incurred may be beneficial for influencing food choices. In addition, a lack of
knowledge and the loss of cooking skills can also inhibit buying and preparing meals from basic ingredients.
Time constraints
Time constraints will prevent individuals from adopting healthy choices especially the young and those that live alone who choose convenience foods. The demand has been met with the introduction of more ready-to-cook meals and pre-packed fruits
and vegetables (instead of loose). Although the convenience foods are more expensive, customers are willing to pay for them.
4. Social determinants such as social class, culture, and social context
Social class/socioeconomic
There are differences in food choices in different social classes which lead to both under- and over-nutrition. For example, people within the higher social class groups tend to have healthier diets (e.g. higher intakes of fruit, lean meat, oily
fish, wholemeal products, and raw vegetables) compared with manual workers. It is thought that higher socioeconomic groups have healthier diets because they may have higher educational levels and may be more health conscious and have healthier
lifestyles. Social class differences in diet are of particular concern with respect to health inequalities.
Cultural influences
Cultural influences impact on diet choices and food preparation – evidence has shown that traditions, beliefs and values are among the main factors influencing preference, mode of food preparation, and nutritional status. Cultural habits,
however, have been shown to change, for example, when individuals move to a new country and adopt the food habits of the local culture. For example, South Asian females migrating to Scotland showed increased fat intakes and this was associated
with an increased body mass index, and incidence of heart disease and type 2 diabetes.
Social Context
Social context includes both the people who have an impact on an individual’s eating behaviour and the setting in which an individual consumes their dietary choice. People influence an individual’s food choices directly and indirectly: buying
food on behalf of an individual is a direct impact whilst learning from a peer’s behaviour (conscious or subconscious) has an indirect impact. Social support (e.g. families) can have a beneficial effect on individual’s food choice by encouraging
and supporting healthy eating practices. The setting for food consumption (e.g. home, school, work, and restaurants) will affect food choice by the availability of food options.
5. Psychological determinants such as mood, stress and guilt
The evidence supporting psychological determinants and food choice is limited and proposed mechanisms for the relationship are complex.
Stress
Stress can trigger changes in human behaviours that affect health; the effect of stress on food choice is complex and individualistic: some people consume more food and make unhealthy food choices and others consume less food. It is believed that
stress induced changes may be due to changes in motivation (e.g. reduced concern for weight control), physiological (reduced appetite), changes in eating opportunities, food availability and meal preparation.
Mood
Food can change an individual’s temperament and mood and influences food choice. Individuals report food cravings (especially among women during the premenstrual phase) and the relationship with food for dieters mean that people may feel guilty
after indulging in food or attempting to restrict food and increasing the desire for the food.
6. Attitudes, beliefs and knowledge about food, and optimistic bias
Attitudes and beliefs
Consumer attitudes and beliefs vary by individual, within groups of a population and across countries. The Pan-European Survey of Consumer Attitudes to Food, Nutrition and Health found that the top five influences on food choice were ‘quality/freshness’
(74%), ‘price’ (43%), ‘taste’ (38%), ‘trying to eat healthy’ (32%) and ‘what my family wants to eat’ (29%). These were average figures for 15 countries but results differed significantly between countries. Females, older subjects, and
more educated subjects considered ‘health aspects’ more important than other factors whilst males rated ‘taste’ and ‘habit’ as the main determinants of food choice.
Optimistic bias
There are a high percentage of individuals who perceive their diets to be healthy and do not believe that they need to make dietary changes. People therefore believe that they are at less risk from a hazard compared to others e.g. people
overestimate their consumption of fruit and vegetables. An individual who considers their diet to already be healthy is less likely to adopt additional healthy eating practices.
References
- Shepherd R. (1999). Social determinants of food choice. Proceedings of the Nutrition Society. 58: 807-812
- Gibney M.J., Margetts B.M., Kearney J.M. and Arab L. Public Health Nutrition. The Nutrition Society.
© Hannah Pheasant 2008