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Educate your patients on the importance of 3-A-Day of Dairy: Here's
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Developed in conjunction with The American Academy of Family
Physicians, The American Academy of Pediatrics, The American Dietetic
Association, and The National Medical Association.
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Dairy Council Digest Archives
Factors Influencing Eating Behaviors
Individual (Personal) Factors Influencing Eating Behaviors
Taste and Sensory Perceptions of Food.
Taste is one of the most important influences on food choices (1,9,10,13-15). According to one survey, the belief that "healthy foods don't taste as good" was cited by 19% of respondents as the major reason they did not eat as healthfully as they should (1). Genetic, physiological, metabolic, and cultural factors influence an individual's taste preferences (16,17). Taste preference for sweetness, which is inborn, is a significant determinant of food choices in young children (16). With respect to cultural food practices, one study found that white girls were more likely to prefer the taste of milk than either Asian or Hispanic girls (17). Also, white girls liked milk served cold, whereas Asian girls preferred milk warm and sweetened in combination with other beverages such as tea. The Hispanic girls preferred milk in the form of shakes, puddings, and flan (17). All groups enjoyed the taste of cheese, pizza, and ice cream. These culturally influenced taste preferences should be considered when developing interventions to increase calcium intakes.
People who enjoy the taste of dairy foods are likely to consume these foods more often and consequently have higher calcium intakes (13,14). In particular, flavored milks are well liked (18-20). A study of elementary school children in Texas found that milk flavor (i.e., chocolate) was the most important environmental factor influencing milk drinking (18). Flavored milk has the potential to increase children's consumption of milk in school (19,20). A recent study found that children who consumed flavored milk had higher calcium intakes but a similar percent of energy from total fat and added sugars compared to children who did not drink flavored milk (19). To improve the calcium status and diet quality of children and adults, it is important to provide them with opportunities to taste a wide variety of dairy foods (10).
Multiple interacting factors impact eating behaviors and ultimately nutrient intake.
Concerns about Fat Intake and Body Weight.
Eating behaviors are influenced by concerns about dietary fat and body weight (16). The fat content of the diet continues to be a top nutrition concern for consumers (2) and weight concerns/dieting, particularly among adolescent girls, are prevalent (9,21,22). Concerns about dietary fat and body weight may adversely affect intake of nutrient dense foods such as dairy foods (13,15,23-26). Findings from a study of more than 34,000 Minnesota adolescents in grades 7 to 12 indicate that dieting and dissatisfaction with body weight are both strongly associated with low intake of dairy foods (23). According to a recent study of 45 girls ages 9 to 12, concern regarding body shape and restriction of food intake may decrease bone growth and development (24). The American Academy of Pediatrics acknowledges that preoccupation with being thin, especially among adolescent girls, and the misperception that all dairy foods are fattening, contribute to low calcium intakes in this age group (26).
However, research indicates that dairy foods can be consumed without increasing calorie or fat intake, body weight, or percent body fat (10,27). Furthermore, emerging research findings suggest that calcium rich dairy foods such as milk, cheese, or yogurt play a role in reducing body weight and body fat in children and adults (28). Individuals concerned about body weight need to be reminded of the wide variety of dairy products available, including reduced fat, low fat, and fat-free milks and other dairy foods that contain just as much or slightly more calcium than their traditional whole milk counterparts (26). Guidance to reduce fat intake and body weight must be counterbalanced by advice to promote optimal calcium and nutrient intake (10).
Physiological and Biological Influences.
Numerous physiological and biological factors such as hunger, gender, age, disease states, and treatments influence food choices (9,16,23). For example, some persons with lactose intolerance may exclude milk and other dairy foods from their diet, thereby compromising their calcium and nutrient intake (10,29-31). Lactose maldigestion is a physiological state in which there is an insufficient amount of the enzyme, lactase, to digest lactose, the major carbohydrate in milk and other dairy foods. Gastrointestinal symptoms (i.e., lactose intolerance) may result from maldigestion of lactose (29,30). Numerous scientific studies demonstrate that lactose maldigesters can comfortably consume dairy foods (29-31). One cup of milk with a meal or two cups of milk a day consumed in divided doses with breakfast and dinner; aged cheeses (e.g., Cheddar, Colby); yogurt with active cultures; and lactose-reduced or lactose-free milks are well tolerated by lactose maldigesters (10,29-31). In addition, gradually increasing intake of lactose-containing foods such as milk improves tolerance to lactose (32). It is important to appreciate that although lactose intolerance may partly explain low calcium intakes due to reduced dairy food consumption in some racial and ethnic groups such as African American, Hispanic, and Asian populations, culturally determined food preferences and dietary practices learned early in life also play a role (31). Acculturation, the process of adapting to a new society, has been shown to increase milk and calcium intake in Asian American and Hispanic American populations (33,34).
Lifestyle Factors.
Perceived time constraints, inconvenience, and high cost of foods are lifestyle factors that influence food choices (9). For example, lack of time is identified as a barrier to healthful eating (15,16,35). One reason given for plate waste in school meal programs is insufficient time for students to eat (35). Healthful eating is perceived by some consumers to be inconvenient and costly (1). Recent economic conditions have increased the importance of low food prices for consumers, especially those of lower socioeconomic status (1,2,36,37). Health professionals need to communicate to consumers that cost need not be a barrier to a healthful diet (38). For example, milk and other dairy foods are recognized as economical sources of nutrients and, in particular, a cost-effective way to meet calcium needs (39-41). Further, dairy products are available in a variety of convenient, ready-to-eat forms.
Knowledge of factors influencing eating behaviors can help explain gaps between actual and healthful diets and be used to develop effective interventions to improve food choices.
Knowledge, Attitudes, and Beliefs.
Knowledge or health information influences food choices (42). A survey of 1,117 adolescents found that those who were knowledgeable about recommended intakes of calcium, calcium's bone health benefits, and the importance of adolescence as a critical time to increase bone mass consumed more calcium than did adolescents who were unaware of this information (43). The association between greater parental nutrition knowledge and a lower prevalence of overweight among children is another example of the importance of knowledge (44). However, knowledge alone does not necessarily translate into healthful eating behaviors (9,42,44). Knowledge may provide the information to implement a behavior change, but it is the individual's attitude or belief that ultimately determines whether or not this knowledge is translated into actual behavior.
Attitudes and beliefs, many of which reflect cultural values, can have either positive or negative effects on eating behaviors. A recent study of adolescents in California found that those with positive attitudes about healthful eating (e.g., believed that healthful foods taste good, that consuming a healthful diet would make them feel better about themselves) intended to consume a healthful diet over the next month (12). On the other hand, adolescents who believe that they are too young to be worried about their health are unlikely to make dietary changes, such as increasing their intake of calcium-rich foods, despite knowledge of calcium's importance to health (15). Likewise, the health benefits of nutrient-dense foods such as milk and other dairy products will not be realized if these foods are believed to be too costly or just for older people (45). Health professionals need to be sensitive to individuals' beliefs and attitudes when providing advice about dietary changes.
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