Finding a strategy to improve the general diet of the community can challenge many health promoters and politicians. One strategy to consider is the distribution of information, which has thus far seemed to be relatively unsuccessful. Public awareness of heath and the role that diet plays in this as a secondary strategy has also unfortunately yielded little results in terms of improved eating habits.43 Despite its own inherent challenges strategies should focus on changing eating behaviours.
1.2.5.1 Behaviour and change
The many determinants of nutritional behaviour provide a whole set of means for intervening in people’s food choices, but closer consideration shows that there are important aspects that hinder dietary change. Any dietary modification may lead to certain gains (like increased health), but to losses, as well (like decreased palatability). Thus, a sustainable change can only be expected if the gains are valued higher than the losses. These aspects need to be carefully considered when designing nutrition and lifestyle- related intervention concepts.
There are various reasons why strategies to change behaviour have failed in the past. These factors include cultural values and ideas, the fact that healthier options are less available, as well as socio-economic and demographic limitations to obtaining healthier options.20
Studies researching food intake have shown that a person tends to continue ingestion of normal habitual and culturally suitable foods, portion sizes and frequency, regardless of the composition of the food items.20 This is of concern with regard to trends in fast-food intake regarding portion sizes and the composition of fast-food, and the impact it has on increased prevalence of obesity and diseases linked to lifestyle.
The media can play an important role in educating the public through raising awareness and can also appeal to the emotions of consumers. Super Size Me, a documentary film on fast-food intake, has been shown to be a powerful tool for nutrition education in young adults. It has positively affected several factors thought to mediate behaviour and employ the process of change (i.e. emotional arousal and consciousness raising). The film illustrates the detrimental effects of a diet consisting entirely of fast-food.53
Research and the success rates of various strategies have shown that education on its own is inadequate in promoting healthy eating. Multi-sectoral collaboration is essential and strategies should involve politicians, consumers, stores, restaurants, chefs, fast-food franchises, health workers and schoolteachers.43 Manipulating the prices of foods through imposing taxes on unhealthy food items or offering financial support for healthy food items might help the population to achieve healthier goals. It has been proposed that tax on hamburgers, chips, chocolates, soft drinks and other unhealthy foods should be introduced to help overcome South Africa’s ever-growing obesity problem.54 Other recommendations have included adding health warnings to fast-food advertisements and only showing or airing these advertisements at certain times of the day.54 It has also been shown that price plays a large role in making food choices and lowering the price of fresh fruit and vegetables by 50% has resulted in two- to four-fold increases in sales at school cafeterias in the US.17 In the South African context, reducing the cost of fresh fruit and vegetables as was the approach adopted by the US is a potential important factor to consider, especially considering the current inflationary pressures being experienced on all food types. Reducing the relative price of ‘healthy’ food could give it the competitive advantage it requires and drive consumer demand.
Many fast-food outlets have expanded their range of foods to include healthier options. In South Africa, popular burger chains have started to include grilled options (opposed to fried options), salads, yogurt and fruit juice on their menus. Unfortunately, the fast-food industry is driven by consumer demand. American fast-food chains started including healthier options in their menus as early as the 1970s, but most of these projects were abandoned as a result of low consumer interest. A consumer report in 1994 showed that
most people continued ordering the less healthy, high-fat options, even when low-fat fast- food items were available.55 Two possible reasons for this exist; firstly, consumers want to indulge in foods they do not eat at home and, secondly, healthier options are often perceived as being inferior in taste to their more fatty counterparts.55 It would be beneficial if the perception that healthier choices lack taste could be changed and if these choices could be promoted by fast-food enterprises.10 On the other hand, educating the public to make informed choices concerning the regular available options, controlling portion size and decreasing the frequency of fast-food intake may prove to provide more sustainable and practical advice with better health outcomes.
According to a Ukrainian study, barriers to healthy eating, in order of preference, included cost, lack of time, self control, selection influences, lack of knowledge, unpleasant foods and resistance to change.31 Gedrich has stated that people tend to have a “loss” aversion, which favours stability over change.56 The gains of health-orientated dietary changes are mostly related to the distant future (e.g. extension of lifespan), are uncertain (e.g. other possible causes of death besides nutrition) and hardly perceivable (e.g. the avoidance of disease cannot be experienced); while the losses refer to the present, are certain and immediately perceivable.56 Considering modern society’s focus on the “here and now”, advocating dietary change related to health benefits in the distant future may be challenging.