Eating behaviour varies by age, gender and other socio-demographic factors such as socio-economic status and ethnic origin. It is therefore important to differentiate dietary interventions accordingly. The World Health Organization, for example, dis-tinguishes five age categories: the unborn child, babies and toddlers, children and adolescents, adults, and the elderly. The WHO calls for particular attention to be paid
to the risk factors for children (especially the environmental factors) and for adults, as it is in this group that the greatest health gains are to be made in the short term. At the same time, the WHO states that successful dietary interventions targeting the elderly are indeed possible, and could well lead to a considerable reduction in the likelihood of disease (WHO, 2003). The following paragraphs present some of the spe-cific characteristics which must be borne in mind when designing dietary interven-tions addressing infants, young people, elderly people in need of care, lower socio-economic groups and ethnic minorities.
Infants
Various factors influence a mother’s choice between breastfeeding and bottle-feed-ing. In most cases, the choice will be made even before the baby is born, perhaps even before becoming pregnant. The determinants of that choice are the norms instilled by the mother’s social setting and her own attitude to breastfeeding. Her main motive for opting in favour of breastfeeding is usually the health of the child. Complications during pregnancy or childbirth, anticipated practical problems, or bad experiences in the past may serve to swing the decision in favour of bottle-feeding immediately after the child is born.
The duration of breastfeeding is primarily determined by the degree to which moth-ers believe they can cope with any problems that occur. The most common reason for discontinuing breastfeeding soon after birth is the mother’s inability to produce enough milk. After three months, the main reason is the difficulty of combining breastfeeding and work. Obviously, breastfeeding is also more difficult when the child is being cared for elsewhere for part of the day. Mothers with lower educational qualifications and those who smoke tend to discontinue exclusive breastfeeding soon-er than othsoon-ers (Burgmeijsoon-er & Reijneveld, 2001).
Because the majority of Dutch mothers do begin with breastfeeding, measures designed to prolong the duration of breastfeeding offer the greatest opportunity of enhancing the level of breastfeeding in the Netherlands. This will entail helping mothers overcome the practical problems involved, the provision of successful exam-ples, and practical measures to facilitate the combination of breastfeeding and work (see also RIVM, 2004).
Young people
Obesity and unhealthy eating behaviour are now particularly prevalent among chil-dren (see section 2.3). When the child is very young, the parents are the main determi-nants of behaviour. Later, this role is taken by the child’s peer group: other children of the same age. Research into the success and failure factors for health interventions in other areas than nutrition suggests that a combination of interventions (such as edu-cation together with an advertising ban) is required in order to be effective. The research further reveals the importance of the school setting (but also that it is diffi-cult to implement interventions within the educational sector). Feedback relating to the interventions is likely to enhance their success. Active involvement of the young
people themselves will also be more effective, although more labour-intensive and hence more expensive (Jansen et al., 2002). The influence of advertising, both in its traditional and newer forms, on the eating behaviour of young people is also seen as an increasingly important factor (see textbox 2.6).
The (vulnerable) elderly
The elderly, particularly those requiring full-time care, are at increased risk of a quali-tatively and quantiquali-tatively inadequate diet (see section 2.3). The prevention of under-nutrition in the elderly is important because they have greater difficulty in regulating their energy balance than their younger counterparts. Once the energy balance is negative, it can be difficult to rectify (Roberts et al., 1994). In order to reduce the effects of undernutrition among elderly persons in care, it is important to recognize the risks and the causes as soon as possible, whereupon timely preventive interven-tions can be advised.
It is here that the principles and opportunities for policy lie. It is important to main-tain appropriate physical activity (Chin A Paw, 1999) and to monitor the body weight of these risk groups among the elderly on a regular basis. A first requirement is there-fore that personnel in the health care sector are trained to recognize the risk factors and remain alert to the warning signs, perhaps relying in part on the simple screen-ing methods already available. The implementation of the multidisciplinary guideline
‘Sensible supply of fluids and nutrition’ (Anon., 2001) deserves consideration by those in the health care sector. Adequate supplements and/or fortified products developed especially for the elderly can also greatly assist in the prevention of undernutrition (De Jong, 1999), while flavour-enhancers and a positive social environment during mealtimes will also have a positive influence (Mathey, 2000; see also RIVM, 2004).
Ethnic groups and the lower socio-economic groups
Various ethnic groups have a high prevalence of overweight, while the lower socio-economic groups display an above-average prevalence of both overweight and other nutritional problems (see section 2.3). Both groups are difficult to reach with health promoting programmes intended for the Dutch general public. Moreover, the resi-dential setting of these groups is often not conducive to good health. Interventions must therefore include additional, specific attention for these groups. Such interven-tions might include ensuring an adequate range of affordable healthy foods is avail-able in the deprived urban areas, and introducing facilities to encourage physical activity. The interventions targeting ethnic groups must also take into account their cultural norms and customs. In many cases, information in the group’s own language and offered by representatives of their own culture will prove most effective (Jansen et al., 2002).