The secrets to changing food behavior, for good

Health behaviors can be defined as “overt behavioral patterns, actions and habits that relate to health maintenance, to health restoration and to health improvement’ (1). This definition includes several behaviors such as diet, smoking, physical activity, alcohol use, sexual behaviors, physician visits, medication adherence, screening and vaccination (2).


Food and dietary behavior have increasingly become a cause of concern since they are often associated with illness and disease such as high blood pressure, cardiovascular diseases, strokes, cancer, obesity and diabetes (3). At this point it is important to distinguish health enhancing from health-impairing behaviors. The first ones express health benefits or protection from disease, i.e. high fruit and vegetable consumption; while the second lead to harmful effects on health or predispose to disease, i.e. high dietary fat consumption, insufficient fiber, fruit and vegetable consumption or excess consumption of calories.


If you consider demographic characteristics including gender, age or ethnic background in relation to diet quality, no clear pattern emerges from the literature. The only evidence-based factor for eating an unhealthy diet, typically also leading to increased risk of overweight and obesity, is low Socio-Economic Status (SES) in terms of educational attainment, work status and income. There are several reviews of eating patterns in industrialized countries demonstrating that lower education and income are associated with the consumption of fewer healthy foods. Additionally, according to many studies, SES is associated with less healthy diet and higher levels of obesity which are factors leading to diet-related disease. Specifically, people who have less money to spend for food, purchase more unhealthy foods because they cost less.


Another factor affecting food choices is the ability to obtain, read, understand, and use health-related information and to make appropriate health decisions. It is widely accepted that there is a lack of nutrition knowledge and apathy towards nutrition intervention messages, especially among people with lower SES (3). Additionally, diet differences can be explained by environmental factors, including neighborhood differences in the availability of healthy foods.


In addition to those limitations set by SES and the environment, humans tend to eat what they are used to eat and what they have learned to like (4). Food behavior is learned behavior and usually reflects routines and habits, reinstitutionalizing an ongoing process of dietary habits each day.


Thus, knowledge is an important factor in helping people to make the ‘right’ choices. Often, nutritional guidelines published by official institutions seem to be complex and do not provide straightforward directions, therefore they need to be simply explained and targeted. Motivation plays a key role in deciding to follow a healthy diet and is associated with attitudes or preferences related to healthy foods: people tend to eat foods they expect will taste good and avoid foods they have negative expectations about.


A key social-cognitive predictor of eating healthily is a belief about one’s own capability of adhering to a healthy diet. This is generally referred to as perceived behavioral control, or self-efficacy. People may perceive barriers that reduce their feelings of being able to maintain a healthy diet. Such barriers include the lack of necessary skills to prepare healthy meals, low availability and/or high price of healthy products, or the time and effort needed to cook healthy dishes. Beliefs that healthy eating is important, together with possessing the necessary knowledge of how to accomplish this behavior, may or may not accumulate into actual intentions to eat a healthy diet (3).


One other factor that is most consistently linked to eating behavior, as a moderator of the intention-behavior link, is habit. Habits are behaviors that occur frequently and automatically. People tend to be automatically drawn towards hedonically appealing, unhealthy, high-fat and high-sugar foods. Therefore, emotions are generally considered to be important triggers for both decreased and increased eating.


One way in which the social environment affects eating behavior is by providing norms for what is appropriate behavior, including family traditions and friends. Additionally, physical and social environment are crucial for changing eating behavior (3). Family members can help someone who already decided he wants to eat more healthily by cooking appropriate meals and not leaving junk food available in the house.


How is technology currently used to change habits


Modern technology, especially Smartphone apps, is likely to be a useful and low-cost intervention for improving diet and nutrition and addressing obesity in the general population. The accuracy of diet and nutrition measurements obtained using mobile devices has generally been found to be good, but not always effective over the long-term. There are currently available several apps including ones designed to encourage healthy eating by reducing educational, behavioral, and economic barriers to accessing healthy, local food (5). On the other hand, many calorie and nutrient tracker apps fail to provide education and knowledge to the users, who just count calories or micro-macronutrients without considering the taste, flavor or satiety caused by foods or food combinations that are healthier.


Until now, researchers have failed to provide effective assistance to help people make healthy food choices for the long-term. To an extent this was due to a retroactive way of dealing with the problem. Most of the technology tools such as mobile phone apps focused on activity and calorie counting but not the promotion of healthy eating. Most would admit that a healthy diet is not only based on caloric numbers because it is not just a matter of quantity but also a matter of quality.


There is a need for culturally appropriate, tailored health messages to increase knowledge and awareness of health behaviors such as healthy eating. Using technology to change dietary habits is more than just goal setting and tracking calorie or nutrient intake. It’s about making good food choices. We need to be more proactive. We need to build applications that not only educate about healthy food choices, but also help people to find their inner motivation and self-competence for change.


Changing behavior doesn’t happen overnight. Therefore, applications should provide a solution that guides people step-by-step towards better health. To even further facilitate behavior change, we need to take into consideration the economical and environmental restrictions, such as SES, food availability and social norms, that may stand in the way of developing new healthy habits. Technology should also be able to provide help for people wishing to overcome these obstacles.


Published on April 17th, 2018


References


  1. Gochman, D. (1997). Handbook of health behavior research. New York: Plenum Press.
  2. Conner, M. and Norman, P. (2017). Health behaviour: Current issues and challenges. Psychology & Health, 32(8), pp.895-906.
  3. de Ridder, D., Kroese, F., Evers, C., Adriaanse, M. and Gillebaart, M. (2017). Healthy diet: Health impact, prevalence, correlates, and interventions. Psychology & Health, 32(8), pp.907-941.
  4. Watson, R. (2017). Nutrition and functional foods for healthy aging. London: Elsevier/Academic Press.
  5. Gilliland, J., Sadler, R., Clark, A., O’Connor, C., Milczarek, M. and Doherty, S. (2015). Using a Smartphone Application to Promote Healthy Dietary Behaviours and Local Food Consumption. BioMed Research International, 2015, pp.1-11.
  6. Coughlin SS, Whitehead M, Sheats JQ, Mastromonico J, Hardy D, Smith SA. Smartphone Applications for Promoting Healthy Diet and Nutrition: A Literature Review. Jacobs journal of food and nutrition. 2015;2(3):021-