Michelle Holdsworth

Psycho-social influences on food choice in Southern France and Central England

This study used attitudinal scales to investigate the nature of attitudes to diet and health in a northern European country (Central England) and a southern European country (Mediterranean France). Cross-sectional studies were conducted using self-administered postal questionnaires that were distributed simultaneously in April 2001 in Montpellier, France and Nottingham, England. A stratified random sample of 1000 males and 1000 females aged 18-65 years was generated from the electoral roll in each country. The final sample comprised England: n = 826 (58% male and 42% female; mean age=44 years) and France: n = 766 (42% male and 58% female; mean age=42 years). This study has demonstrated that the pleasurable and social aspects of eating, certain food quality issues, as well as health as a value were regarded as priorities by French respondents. On the other hand, English respondents reported that organic and ethical issues and convenience were important factors influencing their food choices. In conclusion, the two populations can be differentiated overall in their attitudes and beliefs to food choice.

Motivations of consumers that use local, organic fruit and vegetable box schemes in Central England and Southern France

Commercial fruit and vegetable box schemes are rapidly growing initiatives that allow customers to make local, organic food choices. This study investigated the socio-demographic profile of consumers using local commercial box schemes, and investigated the barriers and motivations of customers. Cross-sectional surveys using identical questionnaires were conducted in Montpellier, France and Nottingham, England. Box scheme users in both countries were primarily rather affluent professionals. The English reported access to local produce that has travelled less food miles (a more altruistic reason) to be the most important motive to purchasing from the box scheme, whereas the French stated quality of produce (a more hedonistic reason) to be key. Both countries ranked ecological commitment and access to organic food as the next most important influences on their participation. The findings reinforce the importance of food quality and pleasure for the French generally, although once this fundamental criterion has been fulfilled, French box scheme users appear equally motivated by contributing positively to the ecosystem. In England, the desire to eat out of season food was cited as the main barrier to making more sustainable food choices. Cost was an important obstacle to increasing consumption of food from sustainable sources in both countries.

Perceptions of healthy and desirable body size in urban Senegalese women

OBJECTIVE: To examine the cultural ideals for body size held by urban Senegalese women; to determine the body size that women associate with health; and to estimate the change in prevalence of female obesity in an urban neighbourhood of Dakar.DESIGN: Cross-sectional, population-based study in the subjects home, using a structured interviewer-administered questionnaire, conducted in the same Dakar neighbourhood as that of a previous survey conducted in 1996.SUBJECTS: A total of 301 randomly selected women, aged 20–50 y, living in a specific Dakar neighbourhood, Senegal.MEASUREMENTS: A total of 32 items concerning body satisfaction, social status, health and individual attributes to associate with one of six photographic silhouettes; body mass index (BMI), waist circumference, waist-to-hip ratio by anthropometry; and measures of economic status.RESULTS: In all, 26.6% of women were overweight (BMI 25–29.9 kg/m2) and 18.6% were obese (BMI ≥30 kg/m2) compared with 22.4 and 8.0% respectively in 1996. Overweight was the most socially desirable body size, although obesity itself was seen as undesirable, associated with greediness and the development of diabetes and heart disease. Lay definitions of overweight and normal weight differed substantially from health definitions, as one-third of the sample saw the ‘overweight’ category as normal. Over a third of women with BMI ≥25 kg/m2 wanted to gain more weight.CONCLUSION: There has been a sharp rise in the prevalence of obesity in Senegalese women living in a Dakar neighbourhood over the last 7 y. In general, overweight body sizes (but not obese) were seen in a positive light. The finding that the term ‘overweight’ made little sense to these Senegalese women could have important implications for developing public health policies.

Effectiveness of preventive school-based obesity interventions in low- and middle-income countries: a systematic review

BACKGROUND The prevalence of childhood obesity is increasing rapidly in low- and middle-income countries, and informed policies to tackle the problem must be defined. OBJECTIVE We systematically reviewed the evidence on the effectiveness of school-based interventions targeting dietary behavior and/or physical activity for the primary prevention of obesity in children and adolescents aged 6-18 y in low- and middle-income countries. DESIGN We searched the MEDLINE, EMBASE, Web of Science, CENTRAL, ERIC, Cochrane Library, and Centre for Reviews and Dissemination databases for peer-reviewed controlled studies published in English, Spanish, French, German, or Dutch between January 1990 and July 2011. The quality of the included studies was appraised independently by 2 authors who used the Effective Public Health Practice Project tool. RESULTS From a total of 7218 unique references, we retained 22 studies. Most of the interventions (82%) had a positive effect on dietary behavior and physical activity behavior (effect size ranged from -0.48 to 1.61). BMI decreased in 8 studies (effect size ranged from -0.7 to 0.0). Effective interventions targeted both diet and physical activity, involved multiple stakeholders, and integrated educational activities into the school curriculum. CONCLUSIONS School-based interventions have the potential to improve dietary and physical activity behavior and to prevent unhealthy body weights in low- and middle-income countries. To reach their full potential, interventions should conduct process evaluations to document program implementation. The effect and the pathways through which interventions have this effect need to be better documented through rigorous evaluation studies.

The SOS-framework (systems of sedentary behaviours) : an international transdisciplinary consensus framework for the study of determinants, research priorities and policy on sedentary behaviour across the life course: A DEDIPAC-study

Ecological models are currently the most used approaches to classify and conceptualise determinants of sedentary behaviour, but these approaches are limited in their ability to capture the complexity of and interplay between determinants. The aim of the project described here was to develop a transdisciplinary dynamic framework, grounded in a system-based approach, for research on determinants of sedentary behaviour across the life span and intervention and policy planning and evaluation. A comprehensive concept mapping approach was used to develop the Systems Of Sedentary behaviours (SOS) framework, involving four main phases: (1) preparation, (2) generation of statements, (3) structuring (sorting and ranking), and (4) analysis and interpretation. The first two phases were undertaken between December 2013 and February 2015 by the DEDIPAC KH team (DEterminants of DIet and Physical Activity Knowledge Hub). The last two phases were completed during a two-day consensus meeting in June 2015. During the first phase, 550 factors regarding sedentary behaviour were listed across three age groups (i.e., youths, adults and older adults), which were reduced to a final list of 190 life course factors in phase 2 used during the consensus meeting. In total, 69 international delegates, seven invited experts and one concept mapping consultant attended the consensus meeting. The final framework obtained during that meeting consisted of six clusters of determinants: Physical Health and Wellbeing (71 % consensus), Social and Cultural Context (59 % consensus), Built and Natural Environment (65 % consensus), Psychology and Behaviour (80 % consensus), Politics and Economics (78 % consensus), and Institutional and Home Settings (78 % consensus). Conducting studies on Institutional Settings was ranked as the first research priority. The view that this framework captures a system-based map of determinants of sedentary behaviour was expressed by 89 % of the participants. Through an international transdisciplinary consensus process, the SOS framework was developed for the determinants of sedentary behaviour through the life course. Investigating the influence of Institutional and Home Settings was deemed to be the most important area of research to focus on at present and potentially the most modifiable. The SOS framework can be used as an important tool to prioritise future research and to develop policies to reduce sedentary time.

The role of social networks in the development of overweight and obesity among adults: a scoping review

BackgroundAlthough it is increasingly acknowledged that social networks are important to our understanding ofoverweight and obesity, there is limited understanding about the processes by which such networks shapetheir progression. This paper reports the findings of a scoping review of the literature that sought to identify the key processes through which social networks are understood to influence the development of overweight and obesity.MethodsA scoping review was conducted. Forty five papers were included in the final review, the findings of which were synthesised to provide an overview of the main processes through which networks have been understood to influence the development of overweight and obesity.ResultsIncluded papers addressed a wide range of research questions framed around six types of networks: a paired network (one’s spouse or intimate partner); friends and family (including work colleagues and people within social clubs); ephemeral networks in shared public spaces (such as fellow shoppers in a supermarket or diners in a restaurant); people living within the same geographical region; peers (including co-workers, fellow students, fellow participants in a weight loss programme); and cultural groups (often related toethnicity). As individuals are embedded in many of these different types of social networks at any one time, the pathways of influence from social networks to the development of patterns of overweight and obesity are likely to be complex and interrelated. Included papers addressed a diverse set of issues: body weight trends over time; body size norms or preferences; weight loss and management; physical activity patterns; and dietary patterns.DiscussionThree inter-related processes were identified: social contagion (whereby the network in which people are embedded influences their weight or weight influencing behaviours), social capital (whereby sense of belonging and social support influence weight or weight influencing behaviours), and social selection (whereby a person’s network might develop according to his or her weight).ConclusionsThe findings have important implications for understanding about methods to target the spread of obesity, indicating that much greater attention needs to be paid to the social context in which people make decisions about their weight and weight influencing behaviours.

The challenges of eating a healthy and sustainable diet

As evidence detailing the detrimental effects of food production on the environment continues to mount, several key areas have emerged as priorities for public health nutrition policy makers, researchers, and practitioners to consider. Climate change is one of those, and in this issue of the Journal, Macdiarmid et al (1) use a mathematical modeling approach to explore how adapting the United Kingdom’s current dietary intake could reduce the impact of greenhouse gas emissions (GHGEs); they do this by identifying which foods meet nutrient requirements while minimizing GHGE contributions and combining these to produce a realistic 7-d diet. To achieve this goal, changes are necessary to existing food-based dietary guidelines to reflect reductions necessary within certain food groups—for example, meat and dairy foods—and increases within others—for example, bread, rice, and potatoes. Such revisions are also timely for health to rebalance nutrient intake and reinforce previous suggestions for food-based dietary guidelines to incorporate sustainability criteria (2). Some European countries, such as Germany and Sweden, have developed guidelines for their citizens that integrate health and sustainability when making food choices (3), although the Swedish guidelines were withdrawn following incompatibility with the European Union’s internal market (4). Both guides recommended choosing seasonal, local, and, where possible, organic fruit and vegetables; consuming less meat and fish; and considering packaging (3, 4). The German advice also advocates purchasing fair trade–certified produce wherever possible (3). The concept of incorporating the sustainability aspects of the human diet with those of nutrition was first evoked more than 20 y ago (5), amid concerns over the environmental implications of food production, as well as identifying the need to incorporate sustainability into nutritional guides to advise citizens. Yet, it is still unclear exactly what constitutes a sustainable diet (6), from either an environmental or a biological perspective, except to say that a diet rich in a variety of plant foods—ie, fruit and vegetables—tends to be more health promoting for both humans and the natural environment (7). Comparisons between vegetarian and nonvegetarian diets have illustrated vast differences in their environmental impact, with the nonvegetarian diet using 2.9 times more water, 2.5 times more primary energy, 13 times more fertilizer, and 1.4 times more pesticides than the vegetarian diet (8). Animal-based foods also generate more GHGEs than do plant-based foods, with the exception of fruit and vegetables grown in greenhouses (9). There are even tensions between human health and the environmental impact of fruit and vegetable consumption, which accounts for ;2.5% of the United Kingdom’s total GHGEs (10), with air-freighted produce, unseasonal produce, prepared (trimmed or chopped) produce, and fragile or highly perishable produce being the major contributors of this sector (10). Tailoring dietary recommendations to regional circumstances, ie, favoring healthy foods that can be produced locally, could provide better outcomes for the environment and public health nutrition (11). Sustainable and certified produce is more expensive, and cost is a recognized barrier to accessing a healthy, sustainable diet (12); this concern has been integrated into Macdiarmid et al’s research (1) by ensuring that the resulting diet remains affordable to the consumer. In creating this diet, the authors have also illustrated the challenge of tackling embedded social norms within everyday eating practices (13). One such example is whole-grain breakfast cereal, which would provide a wide variety of daily nutrients required and a 90% reduction in GHGEs; however, it is ordinarily consumed in combination with milk, which produces far higher GHGEs. Key areas such as meat consumption are also entrenched in social and cultural practices (14) and make up the ‘‘standard’’ British dinner plate, so this diet proposed by Macdiarmid et al (1) is realistic because meat is included on most days, in smaller amounts. Some argue that a meat-free diet is not good for human health because of the nutrients it supplies or for environmental health as grazing livestock play an important role in carbon sequestration, which reduces GHGEs; evidence suggests that the merits of different livestock types to reduce GHGEs largely depend on the scale and type of system in which the animals are reared (15). Even so, the future sustainability of current protein sources such as meat and fish remains one of the biggest challenges for a sustainable food system, and this qualification has been reflected internationally in the nutrition policy agendas of some European countries (16). The research approach taken by MacDiarmid et al (1) is based on sound evidence of dietary intake that uses the most comprehensive life-cycle analysis (LCA) food list currently available, and crucially it acknowledges that GHGEs, although important, are only one part of the wider sustainability picture. (An LCA is

The DONE framework: Creation, evaluation, and updating of an interdisciplinary, dynamic framework 2.0 of determinants of nutrition and eating

The question of which factors drive human eating and nutrition is a key issue in many branches of science. We describe the creation, evaluation, and updating of an interdisciplinary, interactive, and evolving “framework 2.0” of Determinants Of Nutrition and Eating (DONE). The DONE framework was created by an interdisciplinary workgroup in a multiphase, multimethod process. Modifiability, relationship strength, and population-level effect of the determinants were rated to identify areas of priority for research and interventions. External experts positively evaluated the usefulness, comprehensiveness, and quality of the DONE framework. An approach to continue updating the framework with the help of experts was piloted. The DONE framework can be freely accessed (http://uni-konstanz.de/DONE) and used in a highly flexible manner: determinants can be sorted, filtered and visualized for both very specific research questions as well as more general queries. The dynamic nature of the framework allows it to evolve as experts can continually add new determinants and ratings. We anticipate this framework will be useful for research prioritization and intervention development.

Socioeconomic Indicators Are Independently Associated with Nutrient Intake in French Adults: A DEDIPAC Study

Studies have suggested differential associations of specific indicators of socioeconomic position (SEP) with nutrient intake and a cumulative effect of these indicators on diet. We investigated the independent association of SEP indicators (education, income, occupation) with nutrient intake and their effect modification. This cross-sectional analysis included 91,900 French adults from the NutriNet-Santé cohort. Nutrient intake was estimated using three 24-h records. We investigated associations between the three SEP factors and nutrient intake using sex-stratified analysis of covariance, adjusted for age and energy intake, and associations between income and nutrient intake stratified by education and occupation. Low educated participants had higher protein and cholesterol intakes and lower fibre, vitamin C and beta-carotene intakes. Low income individuals had higher complex carbohydrate intakes, and lower magnesium, potassium, folate and vitamin C intakes. Intakes of vitamin D and alcohol were lower in low occupation individuals. Higher income was associated with higher intakes of fibre, protein, magnesium, potassium, beta-carotene, and folate among low educated persons only, highlighting effect modification. Lower SEP, particularly low education, was associated with lower intakes of nutrients required for a healthy diet. Each SEP indicator was associated with specific differences in nutrient intake suggesting that they underpin different social processes.

Systematic mapping review of the factors influencing dietary behaviour in ethnic minority groups living in Europe: a DEDIPAC study.

BackgroundEurope has a growing population of ethnic minority groups whose dietary behaviours are potentially of public health concern. To promote healthier diets, the factors driving dietary behaviours need to be understood. This review mapped the broad range of factors influencing dietary behaviour among ethnic minority groups living in Europe, in order to identify research gaps in the literature to guide future research.MethodsA systematic mapping review was conducted (protocol registered with PROSPERO 2014: CRD42014013549). Nine databases were searched for quantitative and qualitative primary research published between 1999 and 2014. Ethnic minority groups were defined as immigrants/populations of immigrant background from low and middle income countries, population groups from former Eastern Bloc countries and minority indigenous populations. In synthesizing the findings, all factors were sorted and structured into emerging clusters according to how they were seen to relate to each other.ResultsThirty-seven of 2965 studies met the inclusion criteria (n = 18 quantitative; n = 19 qualitative). Most studies were conducted in Northern Europe and were limited to specific European countries, and focused on a selected number of ethnic minority groups, predominantly among populations of South Asian origin. The 63 factors influencing dietary behaviour that emerged were sorted into seven clusters: social and cultural environment (16 factors), food beliefs and perceptions (11 factors), psychosocial (9 factors), social and material resources (5 factors), accessibility of food (10 factors), migration context (7 factors), and the body (5 factors).ConclusionThis review identified a broad range of factors and clusters influencing dietary behaviour among ethnic minority groups. Gaps in the literature identified a need for researchers to explore the underlying mechanisms that shape dietary behaviours, which can be gleaned from more holistic, systems-based studies exploring relationships between factors and clusters. The dominance of studies exploring ‘differences’ between ethnic minority groups and the majority population in terms of the socio-cultural environment and food beliefs suggests a need for research exploring ‘similarities’. The evidence from this review will feed into developing a framework for the study of factors influencing dietary behaviours in ethnic minority groups in Europe.