In the last decades, obesity prevalence shows a general increase in many countries. The prevalence of overweight and obesity is found to be higher in people with lower education levels, which indicates the need to educate the society on health and nutrition. However, the prevalence of obesity is also higher in high-income countries, while in the lower-income and developing countries, obesity is predicted to be more prevalent as the economy advances [3].
Across the globe, national attempts are made to improve (public) health and sustainability of food intake. Through multidisciplinary collaboration between scientists and gastronomic specialists, countries have tried to generate a desirable, healthy, and culturally-accepted dietary guideline. Such efforts are often facing barriers and fighting for acceptance since it requires some lifestyle changes. In many countries, people are unable to comply to the dietary recommendations [2, 10]. Social, economy, and cultural aspects have been reported to be crucial to determine the readiness before changing someone's dietary pattern. For example, women and individuals that belong to high education and income levels are reported to be more inclined to follow healthy eating advice. People who live together either with a partner and/or children seem to make more effort to comply to the guidelines too [4]. Understanding individual's position on the intersection of these aspects is vital for a successful and sustainable dietary change.
During the transition, what do individuals experience that affect their compliance in dietary change?
A wealth of research has focused on the behaviors contributing to the adherence to a diet. In adults or elderly of western populations, in which many dietary intervention studies were conducted, compliance factors are very diverse and summarized below [1, 5, 8, 9]:
Category 1: Issues related to eating habit
Palatability/liking of the diet menu
Familiarity with the new combination of food
Ease of consumption
Less satiety due to changes in caloric intake or food composition
Personal craving/hard to give up preferred foods. The last two aspects are specifically targeted by the ketogenic diet that we discussed last month. As we discussed, keto diet allows its adopters to get the satisfaction from the fatty foods, which may provide a good reason why ketogenic diet is highly preferred by many people.
Category 2: Capital-related issues
Low knowledge or awareness of the benefits
Preparation effort/desire for convenience
Poor cooking skills
Lack of kitchen facilities or improper utensils
Lack of time
Lack of supply of good quality produce
Financial aspect: price/cost of food/value for money. This one aspect could be relevant in Indonesia. Although Indonesia claims itself as an agrarian country, daily and diverse consumption of fruits and vegetables require certain budget which may become a bottleneck for those with low to middle income. This may also explain why adherence to the healthy diet is more commonly found in people with high income, because they have no such constraint.
Category 3: Capital-related issues
Role and family responsibilities, e.g., busy lifestyle/irregular working hours
Influence of other people
Self-control
Low motivation/will power
Resistance to change. Exercise could be a good example of this challenge, also because it closely relates to the dietary and behavior change. If we eat a lot and at the same time, do a lot of exercise, the excess calorie will not give any problem. The problem arises when we know that we don't need as much food with low level of physical activity. Which one is easier, reducing the amount of food consumption according to the low physical activity or increasing physical activity according to the calorie we eat? Both options do not sound easy, do they?
Identifying and overcoming these barriers help in our adherence to the new diet. Important to note, however, different diets might impose different barriers to different people. To understand people perspectives to the lifestyle change, multiple health behavior models to self management are available. One of these models is the trans-theoretical model (TTM) which explains the stages of individuals becoming more engaged to the new diet through 5 sequential stages of change [7].
Precontemplation, defined by a lack of intention to make behavioral changes;
Contemplation, a consideration of changing health behaviors;
Preparation, preparing to and making small changes;
Action, active engagement in behavior change, and
Maintenance, continuing behavior change over time.
Based on this model, individual's self efficacy, i.e., the confidence to overcome such barriers and the readiness to change behavior varies and depend on the state of which they belong to. In principal, the success of dietary changes or intervention relies on the intention, preparation, and commitment to successfully change one's behavior.
Finding a personalized diet fit to your own lifestyle
While nutritional guidelines for healthy eating and proper nutrition intake are undoubtedly useful, they are not universally applicable. A recent study has also demonstrated how the impact of a certain food on blood glucose highly varies across individuals, which really depends on personal and gut microbiome features [12]. After analyzing and profiling an 800-person cohort and measured their responses to 46,989 meals, they devised a machine-learning algorithm that integrates as many parameters one can think of: blood parameters, dietary habits, anthropometrics, physical activity, and gut microbiota. They found that banana, cookies, bread, can result in dramatic difference in blood glucose in different participants. While one person did not experience much elevated blood glucose within 2 hours of cookies consumption, another experienced a complete opposite. When validated their model in an independent 100-person cohort, they accurately predicted personalized postprandial glycemic response to real-life menu. Not only validated their predictive model, they were also able to design a blinded randomized-controlled dietary intervention based on their algorithm. The study elegantly shows the importance of personalized diet by showing how this "personalized diet" significantly lower postprandial responses and consistent alterations to gut microbiota configuration. Such technology will be something we can expect in the (near) future, given the rapid development in science and technology. Meanwhile, we should we should be aware of what personally works for our individual body in relation to our lifestyle.
Moreover, the social and emotional implications of healthy eating remains highly relevant. Stead and colleagues described that healthy eating can be "bad for young people's health" due to self-image, and the fear of deviating from acceptable norms of eating and fitting in with peers [11]. Gender impact on eating habit and preference has also been widely reported. It is a common knowledge, for instance, that males tend to eat more because of higher energy needs and expenditure. Consequently, males have also been reported to prefer fatty and salty foods, e.g., red meat, while females tend to crave sweet foods and might have higher preference for fish and vegetables [6, 10]. Hence, disease risk and prevention can be considerably different between sexes. Ultimately, the long-standing challenge for individuals and policy makers is to swim against the tide and consider all these factors to create a healthier food habit and form a healthier community.
S.A.D Team
Reference
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