Food Environment and Eating Behaviour PDF

Introduction to Eating Behaviour Dr Lee Ching Li [email protected] Food Environment and Eating Behaviour NDT 2126  Lesson Outcomes At the end of this session, you should be able to: Describe the concept of eating and eating...

Introduction to Eating Behaviour Dr Lee Ching Li [email protected] Food Environment and Eating Behaviour NDT 2126  Lesson Outcomes At the end of this session, you should be able to: Describe the concept of eating and eating behaviours Describe the importance of eating and eating behaviours in disease prevention and health promotion  Lesson Outcomes At the end of this session, you should be able to: Describe the concept of eating and eating behaviours Describe the importance of eating and eating behaviours in disease prevention and health promotion What does eating mean to you?  Definitions Eating – Ingestion of food; putting food in the mouth, chewing, swallowing Biological process A physiological need as eating provides energy for living organisms to grow and survive A complex process that involves the brain and other parts of the body.  Definitions Behaviour – the way in which one acts or conducts oneself, especially towards others (Oxford Dictionary) Eating behaviour – a broad term that encompasses food choice and motives, feeding practices, dieting, and eating-related problems such as obesity, eating disorders, and feeding disorders. An environmental phenomenon affecting the dietary preferences and food induced hedonic effect. Factors that influence eating behaviour can be external to self and internal to self  Understanding eating behaviour Why do people eat what they eat? Several approaches to understand eating behaviour  Understanding eating behaviour – developmental model Emphasizes the impact of learning through exposure, social learning, and associative learning Exposure Human beings show a fear and avoidance of novel food: ‘neophobia’ Young children will show ‘neophobia’, but will learn to accept and eat foods 8 – 10 exposures necessary before food preference shift Do we learn which food is safe through exposure?  Understanding eating behaviour – developmental model Emphasizes the impact of learning through exposure, social learning, and associative learning Social learning New behaviors can be acquired by observing and imitating others Social learning (copying) begins when a person has the attentional resources, an ability to retrieve memory, body’s motor control and motivation, to copy a particular person Observational learning or modeling Parental modeling - parental attitudes to food and food choices Peer modeling Television and advertising  Understanding eating behaviour – developmental model Emphasizes the impact of learning through exposure, social learning, and associative learning Associative learning Behaviour can be modified or learned based on a stimulus and a response We are predisposed to learning preference by associating foods with the context and consequences of eating them (Birch, 1999) Rewarding food choice E.g.- If you eat vegetables, we will go to the playground Food as the reward E.g.- If you get an A for your exams, we will celebrate at your favourite restaurant Food and physiological consequences E.g.- I ate something spicy and my mouth hurts. I don’t like spicy food.  Understanding eating behaviour – cognitive model of food choice Emphasizes food choice as the end-product of an individual’s cognitions and explores the extent to which cognition predicts and explains behaviour Health Belief Model  Understanding eating behaviour – cognitive model of food choice Emphasizes food choice as the end-product of an individual’s cognitions and explores the extent to which cognition predicts and explains behaviour  Understanding eating behaviour – psychophysiological model Emphasizes on chemical senses, the impact of psychopharmacological drugs and neurochemicals on hunger and satiety, and the relationships between stress and eating Chemical senses: food appearance and food flavour (smell, taste, spiciness, temperature, texture) Psychopharmacological drugs and neurochemicals: impact of druges on food choice, hunger and satiety E.g.- Nicotine and decrease in food intake, anti-psychotics and weight gain, antidepressants and food cravings, appetite suppressants and reduction in appetite Stress and eating  Understanding eating behaviour – bio-psycho-social-spiritual model Acknowledges the interaction between physical, psychological, social, and spiritual aspects to patient care and patient well-being E.g.- Enjoying a nutrient dense meal with friends/family while exchanging smiles, laughter and kindness, this following a prayer before the meal (bio, psycho, social, spiritual).  Does the developmental model, cognitive model of food choice, psychophysiological model, or bio- psycho-social-spiritual model help you better understand how you eat?  Lesson Outcomes At the end of this session, you should be able to: Describe the concept of eating and eating behaviours Describe the importance of eating and eating behaviours in disease prevention and health promotion  Eating behaviour and health Diet plays a key role in human health and disease prevention. Personal dietary choices involve: What nutrient is consumed E.g.- Macronutrients, micronutrients, phytonutrients What food is consumed E.g.- Food groups, ultra-processed food, organic food, plant-based diet Why, how, under what circumstances food is consumed E.g- Mediterannean Diet, Blue Zone  Eating behaviour and health Understanding eating behaviour helps us observe the complexity of socio- behavioural, economic, environmental, and cultural determinants of the human diet. Many factors influence eating habits and it is important to understand how changes in those factors can affect the human diet, and health.  Eating behaviour and health Obesity System Atlas A visual map of all the relevant factors and their interdependencies that determine the condition of obesity for an individual or a group of people Obesity System Atlas Seven key subsystems Physiology or biology Individual activity Physical activity environment Food consumption Food production Individual psychology Social influences Why does a dietitian need to understand eating behaviour?  Lesson Outcomes Are you able to: Describe the concept of eating and eating behaviours? Describe the importance of eating and eating behaviours in disease prevention and health promotion? Determinants of Eating Behaviour Dr Lee Ching Li [email protected] Food Environment and Eating Behaviour NDT 2126  Lesson Outcomes At the end of this session, you should be able to: Describe an overview of the levels of determinants of factors influencing eating behaviours and food choices Describe how these factors affect eating behaviour across the lifespan  Lesson Outcomes At the end of this session, you should be able to: Describe an overview of the levels of determinants of factors influencing eating behaviours and food choices Describe how these factors affect eating behaviour across the lifespan  Eating behaviour and the environment Environment The surroundings or conditions in which a person, animal, or plant lives or operates Interactions happen in an environment and socio-ecological models helps illustrate these interactions  Eating behaviour and the environment Socio-ecological models help us: Look beyond the individual self Understand the interactions across different levels of the environment Identify and reflect on the factors that influence people’s food choices and eating behaviours Recognise the need for mutual care and shared responsibility Identify barriers to, and promoters of, healthy eating that dietitians/nutritionists can help address Eating behaviour and the environment Knowledge Family Schools Policies and Laws Attitude Peers Workplaces Cultural practices Beliefs Social Neighbourhoods Social structures networks Eating behaviour and the environment Eating behaviour and the environment Plain water or Sugary beverage or Both Can you explain your choice from a socio-ecological perspective?  Lesson Outcomes At the end of this session, you should be able to: Describe an overview of the levels of determinants of factors influencing eating behaviours and food choices Describe how these factors affect eating behaviour across the lifespan  Eating behaviour and the lifespan Human lifespan The length of time for which a person lives Periods of human development over the lifespan Prenatal: Conception to Birth Infancy and toddlerhood: Birth to 2 years old Less defined and Early childhood: 2 years old to 6 years old stable values, Middle and late childhood: 6 years old to onset of puberty behaviours, and Adolescence: Onset of puberty to 18 years old social circles Emerging adulthood: 18 years old to 25 years old More defined and Early adulthood: 25 years old to 40 – 45 years old stable values, Middle adulthood: 40 – 45 years old to 60 – 65 years old behaviours, and Late adulthood: 65 years old onwards social circles  Eating behaviour and the lifespan Sensory- Beliefs, Social & Food choice Biologically affective norms, environmental and determined motivations attitudes, influences behaviours behavioral skills predispositions  Eating behaviour and the lifespan Sensory- Beliefs, Social & Food choice Biologically affective norms, environmental and determined motivations attitudes, influences behaviours behavioral skills predispositions  Eating behaviour and the lifespan Biologically determined predispositions Prenatal period Humans have genetic regions associated with taste, sensory, satiety Multiple genes interact with multiple environmental variables to produce the phenotype (e.g.- a person is more likely to prefer foods or meals with higher amount of fat, protein, or carbohydrate) Barker’s hypothesis of ‘fetal programming’ – adult-onset chronic diseases originates through fetal adaptations to undernourishment  Eating behaviour and the lifespan Biologically determined predispositions Older adults Ageing is associated with a decline in the body’s physiological functions, resulting in structural changes loss of lean mass and a relative increase in fat mass over time Aging is also associated with decline in appetite, taste and smell leading to Decreased food intake Poor food palatability Potential failure to develop sensory specific satiety  Eating behaviour and the lifespan Sensory- Beliefs, Social & Food choice Biologically affective norms, environmental and determined motivations attitudes, influences behaviours behavioral skills predispositions  Eating behaviour and the lifespan Sensory-affective motivations Infancy to early childhood – role of exposure Child is exposed first to breast milk/milk → gradual introduction of solid food Child becomes familiar to a food through repeated exposure to its taste, texture or appearance Exposure to different taste, textures, and appearance during weaning is important for: Development of food preference Lowering of food refusal (familiarization Impacts future food preference Food neophobia a normal part of the developmental stage of early childhood → Positive experiences with food (exposure) can help build healthy eating behaviour  Eating behaviour and the lifespan Sensory-affective motivations Toddlerhood onwards – role of social learning Young children rarely eat alone and tend to copy their main caregiver’s eating behaviour The person copied increases food acceptance Learning through observation or behavioural modelling (copying) Begins when a person has the attentional resources, an ability to retrieve memory, body’s motor control and motivation, to copy a particular person Eating behaviour influenced by main caretaker (e.g.- mother, father) Maternal feeding behaviours related to children's food responsiveness (i.e., their interest in and desire for foods), enjoyment of food, and food fussiness.  Eating behaviour and the lifespan Sensory-affective motivations Early childhood onwards – role of social learning Eating behaviour influenced by peer group Peer group: A group of people of approximately the same age, status, and interests Peer groups share similar environments: Childcare Kindergarten School College, University Workplace Interest groups (e.g.- gym friends, gaming friends) Resistance to peer influence increases with age  Eating behaviour and the lifespan Sensory-affective motivations Early childhood onwards – role of social learning Eating behaviour influenced by media Media: The main means of mass communication (broadcasting, publishing, and the internet) regarded collectively. Exposure to content that centers on unhealthy food and beverages contribute to the adoption of habits that diminish health Certain eating-related social media content was associated with body image concerns and disordered eating  Eating behaviour and the lifespan Sensory-affective motivations Infancy to childhood – role of associative learning Associations formed in several ways: Flavour-Flavour Learning (FFL): Repeated pairing of a new or disliked food with a familiar and liked taste, leads to acceptance of the food in absence of the liked taste Flavour-Nutrient Learning (FNL): New foods are paired with high-energy dense ingredients (e.g.- fat), to enhance post-ingestive satiety signals, exploiting children’s natural preference for energy-densed foods Contamination: Association of a new food with a disliked food Reward: Association of a food with a praise  Eating behaviour and the lifespan Sensory-affective motivations Infancy to childhood – role of associative learning Parenting style affects food preference formation: Authoritarian Authoritative Permissive Parent places high demands Parent controls child eating Parent indulge the child, on the child and controls behaviour but more communicative setting no restrictions on their behaviour; less with the child; sets clear limits when acceptable and communicative responding to child’s food preference unacceptable behaviour. and mood (e.g.- child can control own behaviour but parents respond when child expressed deviant behaviour) Child has lowered dietary Child eating behaviour and Child is over-reliant on variety when the parent is dietary variety responds hedonics for making food not around. best to authoritative choices parenting style.  Eating behaviour and the lifespan Sensory- Beliefs, Social & Food choice Biologically affective norms, environmental and determined motivations attitudes, influences behaviours behavioral skills predispositions  Eating behaviour and the lifespan Beliefs, norms, attitudes, skills Infancy to early childhood First categorization: Food vs non-food As the individual grows older, food is organized into: Taxonomic categories e.g.- fruits, vegetables, meat Thematic categories of items that commonly co-occur e.g.- fish and chips, noodles and soup Script categories of items that play similar role e.g.- breakfast foods Evaluative categories e.g.- healthy or unhealthy, good or harmful, delicious or disgusting  Eating behaviour and the lifespan Beliefs, norms, attitudes, skills Adulthood Middle-aged adults are likely to consider altering food choices for health reasons when first sign of chronic diseases appear Individuals are more likely to change their eating behaviour if their intention is supported by their attitude, subjective norms, and perceived behavioural control At midlife, individuals live in families i.e.- when families share meals, patterns of food choice are established through negotiation Positive family food interactions ( eating together, making decisions) have positive effect on the family's diet quality Older adults Living alone – challenges preparing nutritious meals for one person Decreased autonomy of food selection  Eating behaviour and the lifespan Sensory- Beliefs, Social & Food choice Biologically affective norms, environmental and determined motivations attitudes, influences behaviours behavioral skills predispositions  Eating behaviour and the lifespan Social and environmental influences Adulthood Independent individuals interact with factors at the macro-level (environment) and this affects their food choices and eating behaviour Natural environment, e.g.- vegetable garden outside the home Built environment, e.g.- grocery stores, restaurants Social-cultural environment, e.g.- religious fasting Economic environment, e.g.- household food budget Informational environment, e.g.- food nutrition labels  Obesity is a major health problem Is the solution to simply eat less and move more?  Lesson Outcomes Are you able to: Describe and overview of the levels of determinants of factors influencing eating behaviours and food choices? Describe how these factors affect eating behaviour across the lifespan? Person-related Determinants of Eating Behaviour Dr Lee Ching Li [email protected] Food Environment and Eating Behaviour NDT 2126  What are the factors that influence your eating behaviour? How does understanding the factors that influence eating behaviour affect the work a dietitian does?  Lesson Outcomes At the end of this session, you should be able to: Describe the intrapersonal experience of eating behaviour: perceptions, beliefs, attitudes, motivations knowledge and skills social norms and cultural norms Describe the interpersonal experience of eating behaviour: family and social networks (eg. food purchasing decision influenced by family, peers, co-workers and those in various organizations)  Introduction Eating behaviour – a broad term that encompasses food choice and motives, feeding practices, dieting, and eating-related problems such as obesity, eating disorders, and feeding disorders1. People make decisions about food several times a day: when to eat, what to eat, with whom to eat, and how much to eat – many of these are unconscious decisions2. Biologically determined predisposition towards food can be modified by experience with food3. People also develop perceptions, expectations, and feelings about food. These person-related experience (intrapersonal and inter personal) can influence eating behaviour3. References: 1. LaCaille L. (2013) Eating Behavior. In: Gellman M.D., Turner J.R. (eds) Encyclopedia of Behavioral Medicine. Springer, New York, NY 2. Wansink B & Jeffery S. Mindless Eating: The 200 Daily Food Decisions We Overlook. Environment and Behavior. 2007;39(1):106-123 3. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Food-related determinants of eating behaviour Biology Basic tastes We are born with unlearned biological predispositions toward liking the sweet taste and rejecting sour and bitter taste1 Liking for salt develop several months after birth Preference for fat appears in early infancy or childhood – linked to food texture1 Umami – the 5th taste related to glutamate1 Other sensory experience – irritation from hot chillies and coolness of menthol1 Reference: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Food-related determinants of eating behaviour Biology Hunger-satiety mechanisms Many genetic and biological mechanisms control hunger and satiety1 – more learning in Pathophysiology and Clinical Management of Diseases Today’s obesogenic environment has taken body weight control from an instinctual (unconscious) process to one that requires substantial cognitive effort1. Reference: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Food-related determinants of eating behaviour Biology Sensory-Specific Satiety We have a biologically determined sensory-specific satiety mechanism – get tired of one taste and move on to another over a short time span, such as while eating a meal1. Greater variety of food stimulates bigger meal size and greater food intake2. Reference: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011 2. Roll B. 2000. Sensory-specific satiety and variety in the meal. In Dimensions of the meal: The science, culture, business, and art of eating, edited by H: Meiselman. Gaithersburg, MD: Aspen Publishers.  Food-related determinants of eating behaviour Experience with food People’s liking for specific 2 foods and food acceptance pattern are a result of physiological conditioning/learning arising from positive or negative consequences that people experience from repeated exposure to a food1 Pre- and Postnatal experience Reference: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011 2. Underwood E. The taste of things to come. Science. 2014;345(6190):750-751.  Food-related determinants of eating behaviour Experience with food People’s liking for specific foods and food acceptance pattern are a result of physiological conditioning/learning arising from positive or negative consequences that people experience from repeated exposure to a food1 Physiological conditioning Familiarity – learned safety Conditioned food preferences and aversions Conditioned satiety Reference: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Food-related determinants of eating behaviour Experience with food People’s liking for specific foods and food acceptance pattern are a result of physiological conditioning/learning arising from positive or negative consequences that people experience from repeated exposure to a food1 Social conditioning Social-affective context – social modelling Parenting practices Reference: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Person-related determinants of eating Intrapersonal determinants Person-related experiences can influence eating behaviour: Intrapersonal – within a person Perceptions and beliefs: Is the food tasty, convenient, affordable, filling, familiar, comforting? Personal meaning: What food is tasty, convenient, affordable, filling, familiar, comforting? Values: How important is it for the food to be tasty, convenient, affordable, filling, familiar, comforting? Attitudes: How do I feel think about the food/eating behaviour? e.g. attitude towards breastfeeding, food safety practices Motivations: What reasons do I have to eat a specific food / a certain way?  Person-related determinants of eating Intrapersonal determinants Person-related experiences can influence eating behaviour: Intrapersonal – within a person Knowledge and skills: e.g.- knowledge of how food affects health, being able to cook tasty low-fat dishes Social and cultural norms: Humans are social creatures – we feel compelled to subscribe to what is deemed normal and expected to varying degrees  Person-related determinants of eating Interpersonal determinants Person-related experiences can influence eating behaviour: Interpersonal – between people Humans participate in a network There may be need to negotiate with others in the of social relationships (different family about what to buy or extensiveness, different density) eat. Family Peers Co-workers Relationships with peers and People in organizations we co-workers have an impact on belong to our food choices.  Class Discussion 1. Do you like this food or dislike this food/beverage? 2. What are the food-related and person-related determinants for your preference or aversion to this food/beverage? Food-related determinants Biologically determined predispositions Experience with food Physiological conditioning Social conditioning Person-related determinants Intra-person factors Inter-person factors  Lesson Outcomes Are you able to: Describe the intrapersonal experience of eating behaviour? Describe the interpersonal experience of eating behaviour?  Social and Environmental Determinants of Eating Behaviour Dr Lee Ching Li [email protected] Food Environment and Eating Behaviour NDT 2126  Lesson Outcomes At the end of this session, you should be able to: Discuss social and environmental determinants such as physical and built environment social structure and cultural environment (social relations, cultural practices, social structures, public policy) e.g., multi-ethnic society, pressures of eating with others and social structure economic environment (resources, price, time) informational environment (media and advertising)  Social and Environmental Determinants of Eating Behaviour Physical/Built Environment The built environment (all aspects of the environment that are modified by humans) in relation to food and physical activity have important impacts on health1: Food outlets (e.g.- grocery stores) Homes Schools Workplaces Parks Industrial areas Neighborhood walkability was associated Highways with lower BMI for those living in higher 2 income neighborhoods References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011 2. Lovasi GS et al. Effect of individual or neighborhood disadvantage on the association between neighborhood walkability and boy mass index. Am J Public Health. 2009;99(2):279-284.  Social and Environmental Determinants of Eating Behaviour Physical/Built Environment The built environment (all aspects of the environment that are modified by humans) in relation to food and physical activity have important impacts on health1: Food outlets (e.g.- grocery stores) Homes The availability of fast-food outlets with Schools close proximity in Workplaces residential areas was significantly Parks associated with being overweight among Industrial areas children.2 Highways References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011 2. Cheong KC. Association between Availability of Neighborhood Fast Food Outlets and Overweight Among 5–18 Year-Old Children in Peninsular Malaysia: A Cross-Sectional Study. Int. J. Environ. Res. Public Health. 2019;16(4:593  Social and Environmental Determinants of Eating Behaviour Physical/Built Environment Food availability and accessibility1 Food availability – the array of food options that are present in the food system that are acceptable and affordable Food accessibility – the ‘immediate’ availability (readiness and convenience of a food) How available and accessible are vegetables and fruit, when compared to processed food? References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Social and Environmental Determinants of Eating Behaviour Physical/Built Environment Markets1 The type of food (healthful or not) that is available in neighbourhood grocery stores is influences what people buy and consume. Accessibility is also dependent on where sources of food are physically located. People who have limited mobility may have limited accessibility to food include: Elderly Physically impaired Lower-income group References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Social and Environmental Determinants of Eating Behaviour Physical/Built Environment Workplaces and Schools1 Food available at or near workplaces tend to be those that are convenient, low in cost, and that sell well. Food is generally available and accessible in most workplaces and schools. References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Social and Environmental Determinants of Eating Behaviour Physical/Built Environment Home1 Within the home, accessibility means that a food is not only available in storage but is ready to be eaten. References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Social and Environmental Determinants of Eating Behaviour Social and Cultural Environment Social relations1 Most eating occurs in the presence of other people. This can either have a negative or positive impact in terms of healthy eating. Eating with others can lead to eating more food as compared to eating alone. Children and adolescents who eat with their families on most days of the week have better quality diets than those who eat with their families less frequently. References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Social and Environmental Determinants of Eating Behaviour Social and Cultural Environment Cultural practices and family of origin1 Culture – the knowledge, traditions, beliefs, values and behavioural patterns that are developed, learned, shared, and transmitted by members of a group. Different regions within the same country can have different cultural practices in terms of eating behaviour Immigrants maintain some of their cultural practices in varying degrees - with some influencing eating patterns Cultural rules specify what food is acceptable and appropriate References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011 Laksa photos fromhttps://blog.traveloka.com/en/article/malaysian_laksa/  Social and Environmental Determinants of Eating Behaviour Social and Cultural Environment Social structures and policies1 Organizations we belong to have social norms, policies and practices that can have an effect on our eating patterns: Voluntary organizations – religious, social, community organizations Schools Places of work Professional organizations References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Social and Environmental Determinants of Eating Behaviour Social and Cultural Environment Social structures and policies1 Local, state and national government policy can govern and determine the availability and accessibility of opportunities for healthy eating and active living. References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Social and Environmental Determinants of Eating Behaviour Social and Cultural Environment Social structures and policies1 Local, state and national government policy can govern and determine the availability and accessibility of opportunities for healthy eating and active living. References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Social and Environmental Determinants of Eating Behaviour Economic Determinants Price and resources1 The highest rates of obesity occur among population groups with the highest poverty rates and the least education2. There is an inverse relation between energy density (MJ/kg) and energy cost ($/MJ), such that energy-dense foods composed of refined grains, added sugars, or fats may represent the lowest-cost option to the consumer2. References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011 2. Drewnowski A & Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr. 2004;79:6-16.  Social and Environmental Determinants of Eating Behaviour Economic Determinants Price and resources1 The highest rates of obesity occur among population groups with the highest poverty rates and the least education2. There is an inverse relation between energy density (MJ/kg) and energy cost ($/MJ), such that energy-dense foods composed of refined grains, added sugars, or fats may represent the lowest-cost option to the consumer2. References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011 2. Drewnowski A & Specter SE. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr. 2004;79:6-16.  Social and Environmental Determinants of Eating Behaviour Economic Determinants Time1 The amount of time people spend on food-related activity depends on many factors including employment outside the home and whether families have children. For many households, time constraints may limit personal investments in healthier behaviours. References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Social and Environmental Determinants of Eating Behaviour Informational Environment Media and advertising1 Media – the main means of mass communication (broadcasting, publishing, and the Internet) regarded collectively. The media is the main source of information about food and nutrition for many people: Print media Newspapers Magazines Digital media TV, internet programmes Social media References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011  Social and Environmental Determinants of Eating Behaviour Informational Environment Media and advertising1 Advertising – the activity or profession of producing advertisements for commercial products or services 56% of food advertising time on Malaysian TV channels is spent on food/drinks that are high in fat, sugar and salt2. Non-core food advertising, and predominantly sugary drinks are commonly screened on Malaysian TV channels3 References: 1. Contento IR (ed.) Nutrition Education. 2nd Ed. Jones and Bartlett Publishers, 2011. 2. Karupaiah T et al. What’s on What’s on Malaysian television? - A survey on food advertising targeting children. Asia Pac J Clin Nutr 2008;17 (3):483-491. 3. Ng SH et al. Obesogenic television food advertising to children in Malaysia: sociocultural variations.  Class Discussion 1. Discuss the social and environmental determinants of your eating behaviour during lunch at the university. Physical/Built environment Social/Cultural environment Economic environment Informational environment  Lesson Outcomes Are you able to: Discuss social and environmental determinants of eating behaviour?  Food Environment and Eating Behaviour NDT 2126 : Overview of Food Environment in Urban & Rural Settings April 23, 2024 Copyright (C) 2020. IMU Inspire Empower Elevate Limitations: For internal circulation in the International Medical University ONLY Lesson outcomes Define food environment and its concept Describe the characteristics of the food environment Access Availability Affordability Quality The Concept of Food Environment & its Relevance to Health 3 Food Environment Food environments are the physical, social, economic, cultural and political factors that impact the accessibility, affordability, availability, and adequacy of food within a community or region. 4 Food Environment The food environment plays a role in what people choose to eat. The food environment is defined by: The physical presence of food that affects a person’s diet A person’s proximity to food store locations The distribution of food stores, food service, and other spaces from which food may be obtained A connected system/network that allows access to food Food environments are created by the human-built and social environments. 5  Dimensions of Food Environment Turner et al., Concepts and critical perspectives for food environment research: a global framework with implications for action in low- and middle-income countries. Global Food Security. 2018; 18:93–101 6 Aspects of Food Environment Community food environments are measured by people’s proximity to different kinds of food outlets or the density or variety of different types of food outlets within a specific geographic area. Consumer food environments are characterized by the accessibility, variety, price, and quality of foods, and of consumer information such as promotional signs, as well as relative prominence of healthier versus less healthy food options. Organizational food environments are shaped by features such as food preparation, retailing, or food growing facilities in institutional settings. Food information may be in the form of advertising, labelling, or educational curricula. 7 Food Environment Affects Health Outcomes Turner et al., Concepts and critical perspectives for food environment research: a global framework with implications for action in low- and middle-income countries. Global Food Security. 2018; 18:93–101 8  Food Environments Affect Health Outcomes (cont…) Multiple community settings identified significant associations between the availability (measured as density) of food vendors and BMI, though vendor type was found to have variable associations. The availability of unhealthy foods in and around schools is positively associated with the regular intake of these foods amongst adolescents. SSB consumption correlated with sedentary behavior, frequency of purchasing lunch from school cafeterias and frequency of purchasing snacks from vending machines. However, evidence associating school food environment and student BMI is not conclusive. 9 Healthy Food Environments Healthy food environments provide equitable access to healthy foods. They provide/ make available: opportunities for food production and food distribution networks fresh fruits and vegetables and whole foods in a variety of retail and food service outlets healthier options for prepared and pre-packaged foods community programs and infrastructure All of these enable healthy food consumption and to support healthy eating. 10  Methodological Framework: maps geospatial and observational approaches to food environment domains GIS: Geographic Information System GPS: Global Positioning System Turner et al., Concepts and critical perspectives for food environment research: a global framework 11 with implications for action in low- and middle-income countries.. Global Food Security. 2018; 18:93– 101 Food Environments in Low- or Middle-Income Country (LMIC) 12 Community Food Environments in LMIC Small- and medium-sized market-based vendors dominate LMICs. For example, in Cape Town, South Africa, formal supermarkets did not cater to the needs of the poor, whereas informal vendors provided sources of cheaper, lower-quality foods available on credit. Nonmarket-based food sources were also important in some settings. In communities vulnerable to food insecurity, wild food harvesting may also be important e.g. Brazilian rainforest cities. 13 Community Food Environments in LMIC (cont…) Food deserts: characterized by insufficient availability and accessibility of healthy foods, particularly fruits and vegetables, were widespread in urban communities in Brazil. Food swamps: typified by the inundation of unhealthy foods and drinks, were common in low- and middle-income communities in Mexico. Food oases: identified amongst high-income communities with limited availability of less-healthy options in Mexico. Turner et al., Food Environment Research in Low- and Middle-Income Countries: A Systematic Scoping Review, Advances in Nutrition, 2019; https://doi.org/10.1093/advances/nmz031 14 School Food Environment in the LMIC Multiple settings consistently found school food environments to be saturated with vendors selling unhealthy foods and beverages. Targeted marketing of SSBs to children was also evident. Unhealthy foods and beverages were readily available, affordable, and desirable, whereas healthier options were found to be limited in many school settings. 15 School Food Environment in the LMIC (cont…) Concerns around misleading marketing messages, food safety, and the importance of peer influence in school canteens, the role of food prestige placed upon non-traditional, foods from roadside vendors, restaurants, and small grocery stalls around schools. School policies were found to be highly contested amongst a wide array of actors. For example, proposed policies to regulate the sale of unhealthy foods in schools, had support amongst academics, health professionals, citizens, and parents while food industry concerned about a negative public image, loss of income, and reduced employment opportunities. Guatemala, South Africa, Swaziland, India, Mexico, Mauritius 16 Household Food Environment in the LMIC Traditional family structures and complex eating patterns in Brazil. Perceived low efficacy of low-income mothers to provide their children with nutritious foods in Indonesia. Targeted television marketing and promotion of unhealthy foods to children during school holidays in Malaysia. 17 Rural and Urban Food Environments  Rural and Urban Food Environments – Eg from Nevada Tested the hypotheses of difference in venue density, the availability and quality of produce, and the price difference between standard and healthy items between rural and urban Nevada geographies. Primary data show a greater per-capita density of grocery and convenience venues in the rural area than the urban. A greater per capita density of fast-food venues was found in the urban sample area. 19  Rural and Urban Food Environments – Eg from Nevada (cont…) The variety and quality of produce in the rural grocer venues were lower than the urban supermarkets. No significant or functional price difference was found between the standard and healthier versions of select items within commonly purchased food groups, between rural and urban geographies. 20 Rural and Urban Food Environments - E.g. Texas Fruit and vegetable (FV) intake in urban and rural contexts was studied. Rural sample had more large grocers & convenience stores vs urban sample per 1,000 persons (unexpected!). Density of fast-food venues in rural sample was less but not significantly different from the urban geographies. Distance to supermarket or supercenter: did not affect fruit and vegetable intake in urban areas decreased the FV intake in rural areas 21 Rural and Urban Food Environments - E.g. Texas (cont…) Retail food environments Lower variety and quality have different impacts on scores of produce in the rural FV intake in urban and rural settings. areas. Interventions to improve FV intake in these settings No significant price difference should account for the importance of distance to between rural and urban the retail food environment geographies for non-produce in rural settings. food items. Nickelson, J. "A Rural and Urban Study of the Food Environment in Select Nevada Geographies" (2017). UNLV Theses, Dissertations, Professional Papers, and Capstones. 3019. 22 https://digitalscholarship.unlv.edu/thesesdissertations/3019 Food Intake in Rural and Urban Malaysia Energy intake and Distribution: Energy intake (EI) Males : Rural EI was significantly lower than urban EI (2024 kcal vs 2275 kcal) Females: No difference in mean energy between rural and urban EI (1711 vs 1718 kcal) Energy Distribution Urban males and females: Protein - 14%, Carbohydrate - 55% Fat - 30% Rural : Protein - 13% both males and females Carbohydrate - 65% in males and 66% in females Fat - 19% in males and 21% for females 23 Food Intake in Rural and Urban Malaysia (cont…) Micronutrients: Rural areas = poorer mean intake of vitamins and minerals compared to urban areas. Rural males were deficient, less than two-third RNI in calcium, riboflavin and niacin. Rural women had a poor intake of vitamin A and niacin. Calcium and iron intakes were less than two-third RDA in both the rural and urban women. Overall, only protein and vitamin C intake met the RDA in most subjects from rural and urban areas. Chee SS et al., 1997, Malaysian Journal of Nutrition 24 Recommendations to Improve the Food Environment 25 26 Identifying Gaps in Nutrition and Health - Malaysian Opinions MANS 2014 found MY adults had inadequate intake of fruits, vegetables and wholegrains. Sugar, soy sauce and condiments were staple household items. My Breakfast study (2013) - only a minority of children and adolescents consumed whole grains, at insufficient levels. “Government spending on managing existing cases in the public healthcare system and the predominantly curative approach cannot be sustained.” https://www.thestar.com.my/opinion/letters/2019/10/02/time-to-change-how-we-look-at-nutrition 27 Bridging the Gaps Rice School Food Urgent Need? Programmes fortification with To incentivize and facilitate micronutrient health prevention behaviours, such as: making healthier food choices Minimum taking supplements to nutritional address nutritional Food standards for innovation to cafeteria at deficiencies schools and incorporate adopting healthy lifestyles. workplaces whole grains  Malaysian Food – EPI Recommendations for Food Environment Restrict promotion of unhealthy food and beverage directed at children’s settings and media Set mandatory nutritional labelling (sodium, total sugar and added sugars) on products and to require calorie menu board labelling for all fast-food chains and other food outlets Set sodium targets and investigate food composition standards for added sugar and saturated fat for selected food groups Investigate restriction on opening hours of fast-food restaurants and seek opportunities to restrict the opening of new outlets near schools and residential areas 29  Malaysian Food – EPI Recommendations for Food Environment (cont…) Introduce taxes on sugary drinks with revenues applied to healthy diets for children and investigate price rise in fruits and vegetables Optimise usage of existing monitoring system and provide appropriate feedback and referral mechanism Strengthen access to information and discussion Continue to fund research and nutrition promotion and strengthen sustainable funding for the Malaysian Health Promotion Board 30 References & Acknowledgement: Centre for disease control and prevention (CDC), Atlanta: https://www.cdc.gov/healthyplaces/healthtopics/healthyfood/general.htm University of Wisconsin Population Health Institute: County Health Rankings & Roadmaps program https://www.countyhealthrankings.org/explore-health-rankings/measures- data-sources/county-health-rankings-model/health-factors/health-behaviors/diet-exercise/food- environment-index Harvard School of Public Health: https://www.hsph.harvard.edu/obesity-prevention- source/obesity-prevention/food-environment/ Lytle, L. Myers, A. Measures Registry User Guide: Food Environment. Washington (DC): National Collaborative on Childhood Obesity Research, January 2017. http://nccor.org/tools- mruserguides/wp-content/uploads/2017/NCCOR_MR_User_Guide_Food_Environment- FINAL.pdf. 31 References & Acknowledgement: The World Health Organization: https://www.who.int/bulletin/volumes/93/5/14-145540/en/ Block J Seawrd M, and James P. 2018 Food environment and health In: Neighbourhoods and Health. https://www-oxfordscholarship- com.ezp2.imu.edu.my/view/10.1093/oso/9780190843496.001.0001/oso-9780190843496- chapter-9 INFORMAS: Food-Environment Policy Index (Food-EPI) Malaysia 2019: https://www.informas.org/2019/03/18/food-epi-malaysia/ New Strait Times. March 20, 2019. Malaysia launches first Food-EPI to curb rising NCDs, obesity. https://www.nst.com.my/news/nation/2018/07/393531/malaysia-launches-first-food- epi-curb-rising-ncds-obesity Dr Sangeetha Shyam 32 Lesson outcomes Define food environment and its concept Describe the characteristics of the food environment Access Availability Affordability Quality  Thank you. For more information please contact: Dr Tan Siew Tin Lecturer [email protected] IMU Education Sdn Bhd No. 126, Jalan Jalil Perkasa 19 199201005893 (237397-W) Bukit Jalil, 57000 Kuala Lumpur, Malaysia 603 8656 7228 Copyright (C) 2020. IMU Limitations: For internal circulation in the International Medical University ONLY Formerly known as International Medical University. imu.edu.my HOME AND INSTITUTIONAL LEVEL FOOD ENVIRONMENT AND HEALTH  1 2 3 4 5 Outcome 1. Outcome 2. Outcome 3. Outcome 4. Outcome 5. Describe the Describe the food Describe school Describe the food Describe the home food environment in meals or school environment in objective measures environment schools lunch workplaces of the FE and gaps and how it affects programmes in food environment research in Malaysia health LEARNING OUTCOMES NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 2  HOME FOOD ENVIRONMENT (HFE) Environmental influences on health behaviours.  Home  Community The community FE includes food outlets in the community, which are associated with adults’ food purchasing and dietary behaviours. [1,2] 1. Morland K, Wing S, Roux AD, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002;22:23-29. 2. Turrell G, Blakely T, Patterson C, Oldenburg B. A multilevel analysis of NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR socioeconomic (small area) differences in household food purchasing behaviour. J Epidemiol Community Health. 2004;58:208-215. 3  FAMILY AND HOME ENVIRONMENT  65-72% of children’s daily calories are consumed in the home 3  Home - Physical environment where children spend the majority of their time  Families – Primary social environment where children learn how, what, where and when to eat  Children’s knowledge, attitudes, values and behavioural preferences are formed at an early age 3. Smith LP, Ng SW, Popkin BM. (2013) Trends in US home food preparation and consumption: analysis of NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR national nutrition surveys and time use studies from 1965–1966 to 2007–2008. Nutr J, 12:45. 4  FAMILY AND HOME ENVIRONMENT (CON’T)  Children’s eating patterns are strongly influenced by environmental characteristics.4  Despite the growth of fast food, convenience foods, and trends toward increased eating away from home, about two-thirds of the foods children consume is from home.5  Home and family environments are essential in the development of food preferences and consumption habits, and families represent a promising avenue toward improvement of children’s eating habits and prevention of obesity. 5,6,7 4. Patrick H, Nicklas TA. A review of family and social determinants of children's eating patterns and diet quality. J Am Coll Nutr. 2005;24:83-92. 5. Adair LS, Popkin BM. Are child eating patterns being transformed globally? Obes Res. 2005;13:1281-1299. 6. Birch LL, Davison KK. Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin North Am. 2001;48:893-907. 7. Dietz WH, Gortmaker SL. Preventing obesity in children and adolescents. Annu Rev Public Health. 2001;22:337-353. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 5  HOME FOOD ENVIRONMENT (HFE)  Based on the ecological systems theory (7), the HFE is determined by parents and represents the child’s immediate food environment which acts to support or inhibit healthy eating (8).  It is likely that factors influencing child diet are unique at different age stages.  While it is acknowledged that in early childhood the child is most dependent on parents with dietary intake largely influenced by the HFE (9,10), the contributing influences of the HFE in primary-school children as age increases are unknown. Competing influences such as the media, peers and school environments can also come into play (7). 7. Bronfenbrenner U (1999) Environments in developmental perspective: theoretical and operational models. In Measuring Environment Across the Life Span: Emerging Methods and Concepts, pp. 3–17 [SL Friedman and TD Wachs, editors]. Washington DC: American Psychological Association. 8. Birch LL & Davison KK (2001) Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight. Pediatr Clin North Am 48, 893–907. 9. Wyse R, Campbell E, Nathan N et al. (2011) Associations between characteristics of the home food environment and fruit and vegetable intake in preschool children: a crosssectional study. BMC Public Health 11, 10. 10. Pearson N, Biddle SJ & Gorely T (2009) Family correlates of fruit and vegetable consumption in children and adolescents: a systematic NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR review. Public Health Nutr 12, 267–283. 6  HOME FOOD ENVIRONMENT (HFE)  A broad range of HFE components are related to child dietary intake.  availability and accessibility of fruit and vegetables, parental role modelling and parental intake were most consistently related to higher fruit and vegetable intake (10)  child feeding practices such as encouraging intake of healthy foods were related to lower BMI (11). 10. Pearson N, Biddle SJ & Gorely T (2009) Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review. Public Health Nutr 12, 267–283. 11. Crawford DA, Ball K, Cleland VJ et al. (2012) Home and neighbourhood correlates of BMI among children living in NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR socioeconomically disadvantaged neighbourhoods. Br J Nutr 107, 1028–1036. 7 Conceptual model of environmental factors related to childhood obesity risk Physical environment Access to and availability of foods Access to and availability of Child’s eating Energy activity and sedentary options Intra-individual environment behaviours intake Cue to behaviours Perception of social and physical environments Obesity Knowledge Risk Attitudes Values Social environment Skills Child’s Energy Preferences activity and expenditure Parenting style sedentary Family meal practices behaviours Affective/emotional environment Role modeling Social/cultural norms Moderators:  Family resources (time, money, skills)  Weight of adults in the home  Genetics NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR Lytle LA. Healthy home food environment. IUNS 21st ICN International Congress of Nutrition 8 Conceptual model of environmental factors related to childhood obesity risk Physical environment Access to and availability of foods Access to and availability of Child’s eating Energy activity and sedentary options Intra-individual environment behaviours intake Cue to behaviours Perception of social and physical environments Obesity Knowledge Risk Attitudes Values Social environment Skills Child’s Energy Preferences activity and expenditure Parenting style sedentary Family meal practices behaviours Affective/emotional environment Role modeling Social/cultural norms Moderators:  Family resources (time, money, skills)  Weight of adults in the home  Genetics NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 9  ELEMENTS OF THE HOME ENVIRONMENT THAT IMPACT EATING AND ACTIVITY-RELATED BEHAVIOURS (ESPECIALLY CHILDREN’S)  Availability of foods, activity and sedentary options in the home  Accessibility of foods, activity and sedentary options in the home  Cues to eating, being active and being sedentary  Resources available to the family Smith LP, Ng SW, Popkin BM. (2013) Trends in US home food preparation and consumption: analysis of national NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR nutrition surveys and time use studies from 1965–1966 to 2007–2008. Nutr J, 12:45. 10  AVAILABILITY OF FOODS IN THE HOME  Children’s intake of fruits & vegetables (F&V)  availability of healthy foods in the home (Ding et al, 2012)  Children’s intake of high calorie and high sugary snacks/beverages  availability of less healthy foods in the home (Campbell et al, 2007)  The physical home food environment can be obesogenic or health-protective. Ding D, Sallis JF, Norman GJ, et al. (2012) Community food environment, home food environment, and fruit and vegetable intake of children and adolescents. J Nutr Educ Behav, 44(6):634–638. Campbell KJ, Crawford DA, Salmon J, et al. (2007) Associations between the home food environment and obesity- NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR promoting eating behaviors in adolescence. Obesity (Silver Spring), 15(3):719–730. 11  Model of the home food environment pertaining to childhood obesity Richard R Rosenkranz and David A Dzewaltowski. Model of the home food environment pertaining to childhood NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR obesity. Nutrition Reviews® Vol. 66(3):123–140 12  MODEL OF THE HOME FOOD ENVIRONMENT PERTAINING TO CHILDHOOD OBESITY The domains Macro and Micro levels  Built and natural environments are those  Macro-level: at the larger community level, with composed of physical structures. potential carry-over into the child’s home life.  Political and economic environments are those  Micro-level: most proximal or nearest to a child’s composed of financial resources, policies, and laws. home life.  Sociocultural environments are those composed  Although micro-level components are contained of social interactions, demographic characteristics, within the macro-level, the collection of micro-level and secular trends. components across a population also shapes the macro-level environment.  Components may interact across domains. Richard R Rosenkranz and David A Dzewaltowski. Model of the home food environment NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 13 pertaining to childhood obesity. Nutrition Reviews® Vol. 66(3):123–140  Model of the home food environment pertaining to childhood obesity Richard R Rosenkranz and David A Dzewaltowski. Model of the home food environment pertaining to childhood NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR obesity. Nutrition Reviews® Vol. 66(3):123–140 14  POLITICAL & ECONOMIC ENVIRONMENT – MICRO-LEVEL Family socioeconomic status Family food insecurity  Well-established influence on dietary habits,  Food insecurity: limited or uncertain availability of nutritional outcomes and obesity nutritionally adequate foods;  Income, education, occupation, food programme - strongly related to financial insecurity and poverty eligibility, etc  Food insufficiency: is an inadequate amount of food intake due to a lack of money or resources. Food programmes participation  lack of participation have been offered: stigma, transactions costs, and lack of information NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 15  SOCIOCULTURAL ENVIRONMENT – MICRO-LEVEL Customs and traditions  impact of traditions, culture, religious practices, Parenting: practices, styles and rules ethnicity, race, and related social influences is  Parents can and should play the primary role in controlling the important to consider since many customs and obesogenic environment at home. traditions involve food as a central focus  Permissive parents: warm but not firm, allowing their children great freedoms in behavior and decision-making – less likely to  families who shared meals together more often had set limits or control food choices more similar dietary intakes.  Authoritarian; firm but not warm, set rigid limits, employ punitive and forceful actions of enforcement; negatively related to F&V availability/consumption Family structure, stress, and schedules  Authoritative: warm, firm and accepting of the child’s needs for autonomy; set limits based on reasoning & enforce limits  Dual-earner, single parent families, women in the through persuasion, provide better availability of F&V workforce, makeup and size of families  Using food as a reward – associated with nutritional problems  Family stress may be partially determined by socioeconomics, race, ethnicity, employment, and health. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 16  SOCIOCULTURAL ENVIRONMENT – MICRO-LEVEL Education and nutrition knowledge Parental eating/dieting  E.g., financial income, money management, priority  Parental dietary practices, such as dietary restraint for nutrition, nutritional knowledge, parenting skills, or dietary restrictive practices is a risk factor for general resources, or in other ways. children.  Better maternal nutritional knowledge was associated with better diets in children Family eating patterns Food preparation skills  The family mealtime affect eating behaviours  Limited skill may prevent adults from making improvements to the home food environment  Experts suggest factors such as cooking skill, food usage, motivations, and personality be included in interventions when targeting dietary change in the home NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 17  HOME FOOD ENVIRONMENT AND ASSOCIATIONS WITH DIETARY INTAKE AMONG ADOLESCENTS (WATTS ET AL, 2018)  It was hypothesized that an authoritative parenting style, parent modeling of healthful food choices (FV and low-fat snacks), more healthful family meal practices (fewer meals in front of the TV and at fast food restaurants), reduced availability of less healthful foods and drinks (availability of select high-fat foods or non-diet soft drinks in their home) and high SES (higher education or income level) would be associated with more healthful dietary habits among overweight/obese adolescents.  It was also hypothesized that social influences may indirectly influence adolescent dietary intake through associations with availability of less healthful foods in the home (Fig.). Watts et al. The home food environment and associations with dietary intake among adolescents presenting for a lifestyle modification NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR intervention. BMC Nutrition 2018; 4:3 18  BUILT AND NATURAL ENVIRONMENTS – MICRO-LEVEL Home availability and accessibility of foods  The better the availability and accessibility of nutrient-dense foods in the home environment, the more likely it is that children will choose to eat these obesity-protective foods  Less availability of obesity-protective foods such as fruits and vegetables predict lower consumption levels  More availability of obesity risk-factor foods predict higher consumption  Stockpiling of foods in the home may increase consumption for preferred and convenient products, and when the family is frequently reminded of the food via marketing  Parents are capable of manipulating the availability of foods in the home food environment through their purchases, which can influence children’s eating patterns. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 19  BUILT AND NATURAL ENVIRONMENTS – MICRO-LEVEL Audiovisual media equipment  Irrespective of the advertising source, controlled studies have demonstrated the effectiveness of children’s advertising  resulting in the presence of advertised products at home.  Television  promote an obesogenic home food environment through the following three main avenues of influence: promotion of sedentary behavior, food advertising, and eating while watching TV  Beyond television, modern food marketing impacts the home food environment via internet websites, movie product placement, movie or TV character toy tie-ins, sponsorship of sports teams and icons, postal mail advertisements, newspaper and magazine advertisements and inserts, and even with coupons or vouchers from school programs.  Various public health policies have been proposed to protect children by regulating food marketing to children. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 20  CONCERNS ON HOME FOOD ENVIRONMENT  Having adequate food preparation supplies may also contribute to more frequent and convenient preparation of home meals that are usually more nutritious (Appelhans et al., 2012).  Stocking up on sales of nutritious foods may help save money but may also present pitfalls. Some studies show that having larger quantities of food on hand may lead to greater consumption. (Poelman et al., 2014). Appelhans, B. M., Waring, M. E., Schneider, K. L., Pagoto, S. L., DeBiasse, M. A., Whited, M. C., & Lynch, E. B. (2012). Delay discounting and intake of ready-to-eat and away-from-home foods in overweight and obese women. Appetite, 59(2), 576–584. https://doi.org/10.1016/j.appet.2012.07.009 Poelman, M. P., de Vet, E. W. M. L., Velema, E., Seidell, J. C., & Steenhuis, I. H. M. (2014). Behavioural strategies to control the NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR amount of food selected and consumed. Appetite, 72, 156-165. https://doi.org/10.1016/j.appet.2013.09.015 21  BUILT AND NATURAL ENVIRONMENTS – MICRO-LEVEL Kitchenscapes, tablescapes, platescapes and Kitchen appliances and cooking equipment foodscapes  Food preparation and storage equipment such as  Rooms, furniture, containers, and the structure of food refrigerators, freezers, microwave ovens, ranges, and itself have been shown to modify consumption patterns. conventional ovens, cooking utensils, pots and pans,  Preferred foods that are prominently visible and and other such items accessible, along with larger plates, bowls, cups, and  influences eating behaviours in the home serving utensils  promote greater food consumption  Small kitchens with inefficient designs may discourage Home and community gardens the preparation and consumption of less convenient and more healthful meals  Garden-grown foods can positively impact the diet and budget of families  Structural changes to the micro-scale built environment may offer an effective means to change food intake.  The more frequently a family uses products from gardens, the less obesogenic their home food environment should be. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 22   Class Activity: Home Food Inventory (HFI) checklist  Determining what foods an individual or family usually has on hand  Validated, self-administered  Try this at home! Check your fridge, freezer, shelves, cupboards, tabletop, and any areas.  Check “no” only if the food is not present in your home. Fulkerson JA, Nelson MC, Lytle LA, Moe S, Heitzler C, Pasch KE. The validation of a home food inventory. International Journal of Behavioral Nutrition and Physical Activity, 2008, 5;55. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 23  HFI: OBESOGENIC FOOD AVAILABILITY SCORE (RANGE 0 – 71)  Regular fat dairy What are your  Frozen and prepared desserts scores for  Candy obesogenic food  Savoury snacks availability in the  Sugar sweetened beverages home?  Processed meats  High fat microwavable foods  Added fats  Access to unhealthy food in the kitchen and refrigerator NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 24  HFI items are listed in a checklist type format with yes/no (1/0) response options. Higher scores represent greater availability. In addition, participants were instructed to check whether the vegetable, fruit, and bread items were fresh, frozen, dried or canned, as appropriate. The category order was set up to facilitate ease of completion, beginning with the refrigerated items, followed by frozen items, and non-perishable items. Participants are instructed to look for these foods in all areas of the home where food is stored, including the refrigerator, freezer, pantry, cupboard, and other areas (e.g., basement). Participants were informed that lower fat products may be labeled as "reduced-fat," "low-fat," "light," "nonfat," or "skim." Foods in the dairy, added fats, frozen desserts, prepared desserts, and savory snacks were categorized into regular-fat or reduced-fat groupings; beverages were categorized into regular sugar and low sugar categories; and foods in the two ready- access categories were further subgrouped into healthful and less healthful categories. Although the categorization of foods into healthful and less healthful categories may not be entirely straightforward, we assessed each food by its typical fat and sugar content when determining its category. To assess the overall obesogenic home food availability, a summative score was created that includes regular-fat versions of cheese, milk, yogurt, other dairy, frozen desserts, prepared desserts, savory snacks, added fats; regular-sugar beverages; processed meat; high-fat quick, microwavable foods; candy; access to unhealthy foods in refrigerator and kitchen. The obesogenic home food availability score potential range was from 0–71. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 25  SUMMARY – HOME FOOD ENVIRONMENT  The home food environment can be conceptualized as overlapping interactive domains.  Each type and level of environment uniquely contributes influence in a mosaic of determinants depicting the home food environment as a major behavior setting for child dietary behavior and the development of weight status.  Although we did not address energy expenditure or physical activity here, consideration of both sides of the energy balance equation is essential for the study of obesogenic environments and the development of obesity. Richard R Rosenkranz and David A Dzewaltowski. Model of the home food environment pertaining to childhood obesity. Nutrition Reviews® Vol. 66(3):123–140 NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 26  SCHOOL FOOD ENVIRONMENT NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 27  INTRODUCTION  Health promotion efforts in schools could have a broader impact on eating behaviors and future disease risk.  Youth consume between one-third to one-half of meals at school, making this a crucial setting for interventions that alter the food environment.  Promising school food environment policies include  direct provision of healthful foods/beverages such as fruits and vegetables (F&V),  quality standards for competitive foods and beverages (foods and beverages sold outside of school meal programs),  quality standards (targets for foods, nutrients/energy) for school meals (lunch, breakfast) Mozaffarian D, Afshin A, Benowitz NL, Bittner V, Daniels SR, et al. (2012) Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association. Circulation 126: 1514–1563. pmid:22907934 Micha R, Karageorgou D, Bakogianni I, Trichia E, Whitsel LP, Story M, et al. (2018) Effectiveness of school food environment policies on children’s dietary behaviors: A systematic review and meta-analysis. PLoS ONE 13(3): e0194555. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 28 https://doi.org/10.1371/journal.pone.0194555  PROMOTING DIET AND NUTRITION IN SCHOOLS  Food and Agricultural Organization (FAO): Schools  ideal setting  Reach children at an age when food and health habits are being formed.  Influence families and can be a channel for wider community participation  Promoting better diets and nutrition through schools  increase the health and well-being of students and families  FAO works with governments and schools in supporting the Sustainable Development Goals. Food and Agricultural Organization (FAO), 2019 http://www.fao.org/school- NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 29 food/areas-work/food-environment/en/  HEALTHY FOOD ENVIRONMENT AND SCHOOL FOOD  Refers to all the spaces, infrastructure and conditions inside and round the school premises where food is available, obtained, purchased and/or consumed. √ Nutritional content of these foods √ All information available, promotion (marketing, advertisements, branding, food labels, packages, promotions) and the pricing of foods and food products.  A healthy food environment allows and encourage the school community to make choices for better diets and improved wellbeing. Food and Agricultural Organization (FAO), 2019 http://www.fao.org/school- food/areas-work/food-environment/en/ NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 30  HEALTHY FOOD ENVIRONMENT AND SCHOOL FOOD  How governments can shape healthier school food environments: (FAO) o setting and enforcing nutrition standards for school food, meals and snacks; o making nutritious foods more affordable o restricting the sale and advertisement of food products rich in fat, sugar or salt.  Efforts from public and private sectors: o voluntary adoption of standards for sale of foods, o reformulation of food products o creation of codes of conduct for marketing & advertisement  FAO provides technical support, develops guidance and strengthens the capacities of government institutions and other stakeholders to implement nutrition standards for school food and meals and to develop policies for healthier school food environments. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 31  SCHOOL-BASED FOOD AND NUTRITION EDUCATION (SFNE)  Consists of educational strategies and learning activities, which supported by a healthy food environment, help the school community to improve their diets and food choices.  Promotes a “whole school” approach to SFNE, actively involving all people that interact in the school setting.  Schools settings - one of structured learning, a place where those who influence children’s food perceptions, practices and habits interact.  SFNE capitalizes on this and creates learning opportunities and experiences that can shape healthier food patterns. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 32  INCLUSIVE PROCUREMENT AND VALUE CHAINS  The Home-Grown School Feeding approach  Connects the need for safe, diverse and nutritious food with the production of local farmers and community businesses.  Improve the economic development of small-scale famers and local communities and to strengthen the connection between nutrition, agriculture and social protection through schools.  offers local farmers a regular market (schools) for their production. This can boost local agriculture, create business opportunities for smallholder farmers and other vulnerable producers (including women, youth, and members of traditional communities), and contribute to community socioeconomic development.  It can also increase the value of traditional foods NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 33  INCLUSIVE PROCUREMENT AND VALUE CHAINS  FAO supports governments on building these linkages, and on providing technical assistance, information and policy support on inclusive food procurement to schools.  It also promotes ways and opportunities to enhance the nutrition quality and safety along the school food chain,  These “nutrition-sensitive value chains” can play an important role in shaping healthier and more sustainable local and national food systems. NDT2126 FOOD ENVIRONMENT AND EATING BEHAVIOUR 34  ENABLING POLICY, LEGAL AND INSTITUTIONAL ENVIRONMENT  Coordinati