The 2010 Food and You Survey indicated that large proportions of people in Northern Ireland are consuming considerably more high fat, high sugar foods than is currently recommended, despite knowing the importance of limiting fatty and sugary foods in the diet. This research also highlighted the confusion or lack of knowledge on how starchy foods such as bread, rice, potatoes and pasta can be incorporated into a healthy balanced diet.
In light of these findings, a programme of qualitative research, was commissioned in Northern Ireland and Scotland, to investigate how consumers and health professionals understand healthy eating messages. The aim was to provide a clearer understanding of the general public’s knowledge of food and drinks high in fat and/or sugar and starchy foods. The research also incorporated opinions from health professionals such as dietitians, cardiac rehabilitation nurses, health improvement officers, practice nurses and academics to assess their understanding of how these foods can be included as part of a healthy balanced diet.
The overall aim of the research was ‘to investigate how consumers and health professionals in Northern Ireland perceive and understand healthy eating messages and to recommend ways in which improvements in messaging might be made and implemented.’
The objectives were to:
- explore the underlying perceptions, attitudes and preferences that might explain why most consumers are not eating enough starchy foods
- explore why consumers may be under-reporting their consumption of starchy foods
- understand the positive and negative associations of starchy foods
- explore any differences in understanding/attitudes between different groups of consumers (in relation to socio-economic status in particular)
- explore reactions to current messaging around starchy foods
- explore the extent to which consumers’ over-consumption of food high in fat and/or sugar is due to a lack of understanding of how infrequently these foods should be eaten
- explore health professionals’ views on how food high in fat and/or sugar fit in to a healthy balanced diet for different groups of consumers
- explore the views and experiences of health professionals in relation to more effective messaging
- identify improvements to the messaging around starchy food and food high in fat and/or sugar
Six group discussions were held with consumers in three different regions of Northern Ireland. Participants were recruited on the basis of their age, social class and current living situation, with a mixture of those living alone or with family in each group. In addition, participants were responsible for the majority of the food shopping and meal preparation in the household, given their influence on the food and drink consumed in their home. To supplement the group discussions, a series of 26 in-depth interviews were undertaken with a number of health professionals and academics in the field of diet and nutrition. The in-depth interview was considered the most suitable method of capturing their opinions in this research.
The research showed there are a number of barriers that need to be overcome in order for the public to eat a more balanced diet. Processed foods are perceived to be the cheaper option, and many consumers have poor cooking skills.
Consumers were unaware of how frequently foods and drinks high in fat and/or sugar could be consumed or in what portion sizes. Consumers highlighted that much of the advice they have either heard or read in relation to starchy carbohydrate foods, tends to be conflicting and contradictory. Few consumers were incorporating recommended amounts of starchy foods into their diet, and those who were eating recommended amounts, actually believed they were consuming well above what would be recommended by health professionals.
One significant barrier is a general lack of motivation or willpower to implement dietary changes and typically consumers indicated that they were not concerned about the potential impact diet may have on their health. The media tends to be the main source of information on dietary and nutrition advice and celebrities also appear to have great influence on what people choose to eat. However, consumers claimed that they would be most likely to trust health professionals such as GPs, dietitians and the government with regard to healthy eating messages.
Implications for future messaging
To counter some of the common misunderstandings, it would be important to:
- promote how small amounts of food and drink high in fat and/or sugar can be incorporated into a healthy balanced diet
- counteract opinions that bread, rice, potatoes, pasta and other starchy foods are fattening by informing consumers of their nutritional benefits and why they are essential
A key challenge with future messaging will be to make it empowering to encourage behaviour change. This research has shown ideally messages should:
- be positive, realistic and achievable
- explain what constitutes portion sizes and the frequency with which these portion sizes can be consumed within each food group
- use appropriate terminology, e.g. health professionals are against the use of the word ‘treat’ as people use food as a reward. Instead, the word ‘snack’ is considered more suitable
- be consistent and promote the concept of an overall healthy balance in the diet
Messaging alone will not be enough to encourage dietary change among consumers and it is recommended that a range of areas should be explored including:
- working with retailers and supermarkets to implement pricing strategies and product placement in favour of healthier food choices
- trying to improve people’s food, cooking and budgeting skills
- working with the media and publishers to ensure more responsible reporting of diet and nutrition features
- ensuring that health professionals involved in providing dietary advice undertake compulsory training and/or regularly attend workshops and seminars dedicated to teaching the principles of healthy eating