Barriers and Facilitators of Healthy Eating in Adults
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Research Collection Doctoral Thesis Burger versus broccoli - Barriers and facilitators of healthy eating in adults Author(s): Hagmann, Désirée Publication Date: 2019-10 Permanent Link: https://doi.org/10.3929/ethz-b-000372537 Rights / License: In Copyright - Non-Commercial Use Permitted This page was generated automatically upon download from the ETH Zurich Research Collection. For more information please consult the Terms of use. ETH Library Diss. ETH NO. 26255 Burger versus broccoli – Barriers and facilitators of healthy eating in adults Dissertation for the degree of Doctor of Science of ETH Zurich Désirée Hagmann 1 DISS. ETH NO. 26255 BURGER VERSUS BROCCOLI – BARRIERS AND FACILITATORS OF HEALTHY EATING IN ADULTS A thesis submitted to attain the degree of DOCTOR OF SCIENCES of ETH ZURICH (Dr. sc. ETH Zurich) presented by DÉSIRÉE ASTRID HAGMANN MSc in Psychology, University of Basel born on 22.01.1984 citizen of Olten SO accepted on the recommendation of Prof. Dr. Michael Siegrist Dr. Christina Hartmann Prof. Dr. Joachim Westenhöfer 2019 This thesis was written in the context of the project Swiss Food Panel 2.0 which is funded by the Department of Health Sciences and Technology, ETH Zurich. TABLE OF CONTENTS TABLE OF CONTENTS III LIST OF TABLES VI LIST OF FIGURES VIII SUMMARY X ZUSAMMENFASSUNG XII 1 General Introduction 14 1.1 Introduction 15 1.2 Healthy eating – definitions and evaluation methods 17 1.3 Determinants of food choices 20 1.4 Individual determinants of food choices 21 1.5 Environmental determinants of food choices 25 1.6 The Swiss Food Panel 2.0 27 1.7 Research questions and overview of the thesis 30 References 32 2 Acquisition of cooking skills and their importance for healthy eating 39 2.1 Introduction 41 2.2 Methods 43 2.3 Results 47 2.4 Discussion 53 References 56 3 Motives for meat avoidance and reduced meat intake 60 3.1 Introduction 62 3.2 Methods 64 3.3 Results 69 III 3.4 Discussion 78 References 81 4 Intuitive eating and food choices 85 4.1 Introduction 87 4.2 Methods 89 4.3 Results 99 4.4 Discussion 105 References 112 5 Self-control as a moderator of the effect of hedonic hunger on overeating and snacking 115 5.1 Introduction 117 5.2 Methods 119 5.3 Results 123 5.4 Discussion 130 References 132 6 Public acceptance of interventions aimed at reducing sugar intake 135 6.1 Introduction 137 6.2 Methods 140 6.3 Results 145 6.4 Discussion 156 References 160 7 Nutrition labels and their effect on healthiness perception of salty snack food 165 7.1 Introduction 167 7.2 Materials and Methods 171 7.3 Results 179 7.4 Discussion 185 7.5 Supplementary Materials 189 IV References 191 8 General Discussion 195 8.1 Introduction 196 8.2 Central findings and implications for research and practice 196 8.3 Limitations of the studies 204 8.4 Final conclusions 208 References 209 DANKSAGUNG 213 CURRICULUM VITAE 214 V LIST OF TABLES Table 1.1 Classification of weight status in adults based on the Body Mass Index ([BMI]; WHO, 2008). ........................................................................................................ 16 Table 1.2 Dietary recommendations for healthy adults (Swiss Society for Nutrition, 2011)...18 Table 1.3 Socio-demographic characteristics of the Food Panel 2.0 study sample.............29 Table 1.4 Overweight and obesity in males and females of the Swiss Food Panel 2.0 compared to the general Swiss population. ......................................................... 29 Table 1.5 Overview of the chapters, topics and research questions included in the thesis....31 Table 2.1 Description of the study sample............................................................................43 Table 2.2 Associations of cooking skills with food intake, diet quality, and eating habits in male and female participants of the Swiss Food Panel survey 2018. ................. 48 Table 2.3 Predictors of cooking skills among men and women............................................52 Table 3.1 Items assessing motives for no or low-meat consumption...................................65 Table 3.2 Foods and beverages included in the diet quality index.......................................68 Table 3.3 Perceived difficulty of low or no meat intake, diet quality, and weight of adult males and females separated by self-reported diet styles. ............................................ 71 Table 3.4 Consumption of animal- and plant-based proteins (weekly portions) by adult males. ............................................................................................................................. 73 Table 3.5 Consumption of animal- and plant-based proteins (weekly portions) in adult females. ............................................................................................................... 74 Table 3.6 Hierarchical multiple regression analysis predicting total meat consumption in adults who reported eating little or no meat. ........................................................ 76 Table 3.7 Correlations of total meat consumption and predictors. Calculations based on the subsample of participants who reported eating little or no meat. ........................ 77 Table 4.1 Sociodemographic characteristics of the study population..................................90 Table 4.2 Food group compositions, standard portion definitions, mean values and standard deviations for the number of standard portions consumed per week of the different food groups assessed in the semiquantitative food frequency questionnaire. .... 93 Table 4.3 Rotated component matrix for the IES-2 for different subsamples of the Swiss Food Panel. ................................................................................................................... 95 Table 4.4 Cronbach’s alpha for the Intuitive Eating Scale-2 (IES-2) total score and the four subscales separately for gender and the two language versions. ....................... 99 Table 4.5 Rotated component matrix of the IES-2 (varimax rotation), data from the Swiss Food Panel. ....................................................................................................... 100 VI Table 4.6 Means, standard deviations and inter-correlations for the Intuitive Eating Scale-2 (IES-2) total score and the four subscales. ....................................................... 103 Table 4.7 Pearson correlations for the associations between Intuitive eating (IES-2), food intake, physical activity level and BMI. .............................................................. 104 Table 4.8 Pearson correlations for the associations between Intuitive eating (IES-2) and participants’ perceptions of their diet and diet-related health consciousness. ... 107 Table 5.1 Sociodemographic characteristics, hedonic hunger, and self-control in males and females of the study sample. ............................................................................. 119 Table 5.2 Mean values (SD) and correlations for Power of Food Scale scores, overeating and snacking variables. ..................................................................................... 121 Table 5.3 Results of four moderation analyses with self-control as moderator for the relationship between Power of Food and overeating frequency as well as snacking behavior. ............................................................................................................ 124 Table 6.1 Items used to assess acceptance of different interventions to reduce sugar intake (English translation). .......................................................................................... 143 Table 6.2 Pearson correlations between socio-demographic, dietary, and health-related variables. ........................................................................................................... 146 Table 6.3 Mean acceptance of different interventions for participants from the German- and French-speaking parts. ...................................................................................... 150 Table 6.4 Hierarchical regression analysis predicting general acceptance of interventions aimed at reducing sugar intake in the population. ............................................. 151 Table 6.5 Mean acceptance ratings of the four clusters for each intervention strategy.....153 Table 6.6 Description of the four clusters by means of different characteristics................154 Table 7.1 Characteristics of the salty snack products used in the choice task...................172 Table 7.2 Study participants in each condition: Recruited sample, excluded participants and demographic characteristics. ............................................................................. 178 Table 7.3 Exploratory analysis of the perceived usefulness of different types of nutrition information. ........................................................................................................ 183 Table 7.4 Public support of a mandatory implementation of the MTL and Nutri-Score labels. ........................................................................................................................... 184 VII LIST OF FIGURES Figure 1.1 An ecological framework of the determinants of food choices (Story et al., 2008). ............................................................................................................................. 20 Figure 1.2 Flow chart of the Swiss Food Panel 2.0 study sample.........................................28 Figure 2.1 Boxplots of cooking skills among men and women..............................................47