Study suggests positive attitudes toward healthy eating mean higher quality diets within each cost level of supermarkets.
Originally published on Food, Nutrition & Science.
Supermarket shoppers that attach importance to good nutrition have higher quality diets, regardless of the socio-economic level of the market they shop at, according to a study from the University of Washington in Seattle and published in a recent issue of theJournal of the Academy of Nutrition and Dietetics.
“Ensuring physical access to supermarkets has been the focus of public health research and policy to improve diets and health over the past few years. Seattle-King County in Washington State is one of many such parts of the U.S. which does not fit this criteria. Our research shows that everyone in this county has physical access to supermarkets for their food shopping but we still observed huge disparities in their dietary intakes and health. This motivated us to examine some of the other factors that may explain where people shop, what they choose to eat and why. Moreover, I firmly believe that if you are motivated to eat healthy and prioritize it well, you can achieve a healthier diet. This further encouraged me to test this hypothesis using our King County Sample from the Seattle Obesity Study,” says study co-author Dr. Anju Aggarwal.
In this study, 13 supermarket chains were investigated and separated into three categories for low, medium and high cost, and 963 adults were sampled. Diet quality was measured looking at energy density, mean adequacy ratio and total servings of fruits and vegetables.
After adjusting for socio-demographic variables, positive attitudes toward healthy eating were associated with higher diet quality, including lower dietary energy density and more daily servings of fruits and veggies. In fact, compared to those with a neutral or negative attitude, the mean daily intake of fruits and vegetables was about 1.13 servings higher among those with a somewhat positive attitude and 2.25 servings higher among those with a highly positive attitude. Breaking it down further, within low-cost supermarket shoppers, those with highly positive attitudes had fruit and veggie intakes that were twice as high as shoppers who had neutral or negative attitudes.
Interestingly, shoppers with positive attitudes also shopped at low- and medium-cost supermarkets, in addition to higher cost supermarkets. Healthy eating was not restricted to high-cost markets, and those with positive attitudes toward healthy eating achieved higher-quality diets within each cost level of supermarkets, independent of their socio-economic status. Since shopping at low-cost supermarkets has been perceived as a barrier to achieving higher quality diets, this study should serve as a positive reminder that consumers can achieve good nutrition with the right attitudes in place.
“In general, shoppers of high-cost supermarkets such as Whole Foods and PCC tend to be from higher income and education groups and tend to have higher diet quality. By contrast, low- and medium-cost supermarket shoppers (such as Fred Meyer, Albertsons, Safeway) tend to be from lower income and education groups. However, our study sample showed that if you are motivated to eat healthy, it doesn't matter where you shop. Having a positive attitude towards healthy eating helps you to make healthier food choices, even if you shop at low and medium-cost supermarkets. In other words, as long as availability of healthy foods across supermarkets is not an issue and as long as you are motivated to prioritize healthy eating, it doesn't matter where you shop. You can achieve equally higher quality diets while shopping at Whole Foods as well as Safeway and Fred Meyer,” says Aggarwal.
So the question is, how do we achieve those key positive attitudes? Ensuring physical access to supermarkets (because of the food desert plight) has been one successful strategy in improving diet quality among risk groups. But health professionals should also be tasked with providing continued nutrition education and motivational strategies for consumers to learn about healthy lifestyles and shape their attitudes in a positive direction toward healthy eating, and therefore, shopping. The perceived higher cost of healthier foods is yet another barrier that needs to be addressed.
“Based on the current dietary patterns of Americans, our research has shown that healthier diets do cost more. However, there are two messages that need to be clearly promoted among consumers: 1) all healthy foods are not equally expensive, and 2) eating healthy need not always cost more as long as you attach importance to good nutrition and prioritize it. This may involve taking out quality time for food shopping and cooking at home, making an effort to prioritize the healthfulness of foods over convenience and taste, and this may also sometimes mean going beyond mainstream foods in the American diet for healthier affordable options such as beans and lentils, or cheaper forms of fruits and vegetables. These messages need to be promoted among consumers at multiple levels – right from policy to community to the supermarket level,” says Aggarwal.
Bethany Thayer, MS, RDN, Media Spokesperson for the Academy of Nutrition and Dietetics, adds that consumers need a “re-education” on what they are actually getting for their money. When consumers are looking at foods, they should consider not just how many calories they are getting for their dollar but also how many nutrients they are getting for their dollar.
For example, a dollar can buy a candy bar or an orange. The candy bar will be 250 to 350 calories with virtually no nutrients while the orange provides 60 to 80 calories and 100% of your Vitamin C needs, potassium, fiber and other nutrients our body needs to stay healthy. However, the majority of our population isn’t calorie-deficient, but may be nutrient-deficient. And sometimes the healthier food is perceived as more work. Opening a candy bar wrapper may seem like less work than peeling an orange, says Thayer.
“It is really about education and culture change. In this particular study access to a grocery store did not appear to be a barrier. However, when you look at the percentage of individuals in each socio-economic category, it did appear that that those in the lower socio-economic group were less likely to say that eating healthy food was important to them when compared to those in the higher socio economic group. Therefore, it may be particularly important to provide nutrition education strategies in the grocery stores in lower socio-economic neighborhoods. In general, we need to shift perceptions, no matter what economic group an individual is in, and make clear that eating healthy is important for feeling better, looking better, improved energy, and so on,” says Thayer.
Thayer adds that retailers and health professionals can also set up stores to make it easier to grab the healthier choices. Incorporating additional strategies such as food preparation, cooking in large batches, meal planning, and how to utilize coupons, are important too.
Past studies have shown that there is a link between food attitudes and diet quality – but they did not include the third measure this study had of socio-economic status. This study suggests that regardless of socio-economic status, if an individual feels that it is important to them to eat healthy food – they will choose it.
“Supermarket level is a crucial point of intervention because the majority of the food choices are made inside the supermarket. We can design nutrition education and awareness programs for the retailers, which can be implemented at the local supermarket level, particularly at those supermarkets catering to lower socio-economic groups. Educational materials can be developed and distributed to shoppers, as soon as they enter the supermarket, to help guide them on how to make healthier food choices within the budget. Store managers might be trained to help their shoppers make healthier affordable food choices. And supermarket shelves can be labeled to promote affordable, healthier food items,” adds Aggarwal.
Funding for this study came from NIH R01DK076608. The Principal Investigator of the study was Dr. Adam Drewnowski.