Population Determinants of Unhealthy Foods and Beverages

by

Rachel J. L. Prowse, Kim D. Raine

• LAST REVIEWED: 27 April 2017
• LAST MODIFIED: 27 April 2017
• DOI: 10.1093/obo/9780199756797-0160

Introduction

A population perspective on determinants of health behaviors, such as eating, seeks to understand how individuals interact with their environments. Features of environments that impact behavior range from local settings to broad cultural or political influences. Multiple conceptual frameworks (see especially the work of Laura Brennan, Karen Glanz, Mary Story, et al., in the Annual Review of Public Health and American Journal of Health) and narratives (a good example is Kim Raine’s Determinants of Healthy Eating in Canada: An Overview and Synthesis) may be useful in understanding the multidimensional nature of population determinants of eating (all works cited under General Overviews and Theoretical Frameworks). First, eating behavior can be impacted by different ecological levels (individual to collective/ environmental) (see Raine’s Determinants of Healthy Eating). Secondly, eating can be influenced by several types of environments (see Brennan, et al’s “Accelerating evidence reviews and broadening evidence standards to identify effective, promising, and emerging policy and environmental strategies for prevention of childhood obesity” in the Annual Review of Public Health). Third, the impact of environmental influences may vary depending on an individual’s perception of the environment and their life stage. Above all, each level and dimension is part of an interconnected, reinforcing system which can produce and reproduce eating behaviors, making it extremely complex to effectively intervene. At the individual level, factors such as physiological and psychological states, food preferences, and knowledge contribute to diets; however, individual factors are “necessary, but not sufficient to explain eating behavior” (p. S9). Collective environmental influences generate the context for our eating decisions by dictating what food is available, affordable, and acceptable to eat (see Raine 2005, cited under General Overviews and Theoretical Frameworks). Models of environmental determinants of (un)healthy eating have evolved over time to include five broad categories of collective influences on behavior: physical, economic, social, communication, and political (see Brennan). Organized by environment type, key resources are provided to explore population determinants of (un)healthy eating, the interaction between different environment types and the intersection of the individual and their environments. Any student, researcher, practitioner, or policymaker involved in areas relevant to public health nutrition (such as dietetics, geography, urban planning, business, economics, social assistance, job creation, food security, nutrition education, marketing, immigration, surveillance, or politics, to name a few) will find valuable references here. This article will impart knowledge on how to study, develop, implement, and monitor effective population interventions to improve diet. Compared to individual-level interventions, such as dietary counseling, population interventions can have a far-reaching impact by targeting distal determinants of diet and health. For example, this review provides a sample of population interventions (including how we design cities, distribute income, use food, and regulate industry) and indicates how policies and programs can be used at multiple levels to reduce unhealthy eating.

General Overviews and Theoretical Frameworks

Few overviews on population determinants for (un)healthy food and beverage consumption have been published. Those that exist provide a combination of evidence on individual and collective environmental factors impacting eating behavior. Sleddens, et al. 2015 provides an umbrella review of systematic reviews on the influences of youth diets, looking at four environments (physical, social, economic, political) as well as socio-cognitive factors. Mixed findings for environmental factors may reflect the immaturity and quantity of research available on the topic, as well as its complexity. Since healthy and unhealthy eating are not mutually exclusive behaviors, the determinants of healthy eating can provide insight into the same for unhealthy eating. Raine 2005 uses a population lens to explain why groups may or may not meet food and nutrition recommendations and why multilevel collective approaches will be effective in promoting healthy eating in populations. Three significant theoretical frameworks that depict the relationship between several determinants and food consumption include Glanz, et al. 2005; Brennan, et al. 2011; and Story, et al. 2008. All have been cited extensively and have been used to inform and explain research on population determinants of healthy and unhealthy eating. These frameworks share similarities in that each considers multiple environmental factors but differ in how these factors relate to one another, the individual, and eating behaviors. Glanz, et al. 2005 centers on features of the physical food environment that impact how individuals perceive their environment and their behaviors. Conversely, Brennan, et al. 2011 focuses on several different types and levels of environmental factors (physical, economic, social, and communication) situated within multiple political contexts. Bowen, et al. 2015 and Olstad, et al. 2014 are two examples where these theoretical frameworks have been used to research and evaluate interventions and actions. Story, et al. 2008 is a third framework that presents determinants using an ecological model where an individual is placed within multiple distal and proximal social, physical, and political environments.

• Bowen, Deborah J., Wendy E. Barrington, and Shirley A. A. Beresford. 2015. Identifying the effects of environmental and policy change interventions on healthy eating. Annual Review of Public Health 36:289–306.

  DOI: 10.1146/annurev-publhealth-032013-182516

  Utilizes the Glanz, et al. 2005 framework to explore the evidence on existing and potential interventions on influences of diet. Examples of intervention reviewed at each level of the framework: government policies (assistance programs, menu labeling, food taxation), information (marketing to children), food environment settings (organizations, neighborhoods, retail outlets), and the perceived nutrition environment.

• Brennan, Laura, Sarah Castro, Ross C. Brownson, Julie Claus, and C. Tracy Orleans. 2011. Accelerating evidence reviews and broadening evidence standards to identify effective, promising, and emerging policy and environmental strategies for prevention of childhood obesity. Annual Review of Public Health 32:199–223.

  DOI: 10.1146/annurev-publhealth-031210-101206

  Positing poor diet as a cause of childhood obesity, this article breaks down the types of environments (physical, economic, social, communication) and situates them within local, regional, and national policy contexts as determinants of diet. Useful to understand how political features at various levels influence each environment type and to inform multilevel practical interventions or research.

• Glanz, Karen, James F. Sallis, Brian E. Saelens, and Lawrence D. Frank. 2005. Healthy nutrition environments: Concepts and measures. American Journal of Health Promotion 9.5: 330–333.

  DOI: 10.4278/0890-1171-19.5.330

  Original framework describing how individual eating behavior is influenced by features of various food environments (retail areas, communities, home, work, and school), as well as information and media and government policies. Considers how individuals, their attitudes and beliefs, and environmental factors interact to produce behavior. Can inform food environment interventions and research.

• Olstad, Dana L., Kim D. Raine, and Candace I. J. Nykiforuk. 2014. Development of a report card on healthy food environments for children in Canada. Preventive Medicine 69:287–295.

  DOI: 10.1016/j.ypmed.2014.10.023

  Operationalizes the Brennan, et al. 2011 environmental framework to explore how environments, interventions, and policies in Alberta, Canada, support or create barriers for healthy eating and healthy weights in children. Explores using expert rankings of the quality of environments based on achievement of a priori indicators and benchmarks. Emphasizes healthy eating promotion through a “whole society” approach.

• Raine, Kim. 2005. Determinants of healthy eating in Canada: An overview and synthesis. Canadian Journal of Public Health 96.S3: S8–S14.

  DOI: 10.17269/cjph.96.1499

  Emphasizes collective determinants of eating, such as environmental and policy contexts and how individual factors interact with contextual factors. Gives several examples within each category of determinants. Highlights need for population health promotion approach to nutrition. Clear overview for anyone new to population nutrition.

• Sleddens, Ester, Willemieke Kroeze, and Leonie F. M. Kohl, et al. 2015. Determinants of dietary behavior among youth: An umbrella review. International Journal of Behavioral Nutrition & Physical Activity 12:1–22.

  DOI: 10.1186/s12966-015-0164-x

  Review of systematic reviews that assesses influences at individual and environmental levels and interactions between the two on the eating habits of youth. Useful starting point to find systematic reviews on a specific influence or aspect of diet. Highlights concerns with available research on this topic.

• Story, Mary, Karen M. Kaphingst, Ramona Robinson-O’Brien, and Karen Glanz. 2008. Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health 29:253–272.

  DOI: 10.1146/annurev.publhealth.29.020907.090926

  Ecological framework of the determinants of diet that includes nested levels of influence: personal characteristics, social factors, features within settings (schools, work, communities, stores) and broad policy, program, and societal factors. Highlights that individuals are surrounded by multiple environmental factors influencing their food choices.