Food Preference and Influences Notes

  • Chapter 4 : Lesson 1: Food Preference and Influences

    • Health and wellness are popular terms in the nutrition industry.
    • A healthy lifestyle includes nutrition, and food choices are influenced by the environment.

  • Learning Objectives:

    • Explain the effects of nutritional intake on individual health.
    • Identify the role of dietary habits in overall health.
    • Identify environmental and social influences on dietary patterns.
    • Describe factors that influence dietary patterns.
    • Recognize the limitations and dangers of a one-diet-fits-all approach.
    • Identify how culture, age, geographic region, and socioeconomic status influence dietary eating patterns.

  • The World Health Organization (WHO):

    • The international public health agency of the United Nations.
    • Focuses on the development and promotion of international public health and wellbeing efforts. Is considered the world’s public health department.

Defining Health and Disease

  • The WHO defines health as:
    • A state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity.
    • Health is an ever-changing condition due to adjustments to internal and external situations.
  • Homeostasis:
    • The human body is uniquely designed to respond to stressors to maintain optimal health and physiological functioning.
  • The Spectrum of Health:
    • Objective state in which the body is functioning, ranging from a high level (optimal well-being), to moderate compromise (transition zone), to a state of poor health.
    • Poor health often accounts for multiple physical and mental pathologies, which may or may not be preventable or recoverable.

Disease

  • A general definition of disease includes any abnormal condition that negatively affects the structure or function of a part of the body.

  • Diseases can affect one area of the body or they can be systemic, affecting every part of the body (e.g., various forms of cancer).

  • Diseases may be caused by external conditions or internal problems and are further classified by their specific signs and symptoms.

  • Classification of disease is typically broken down further into two categories: noncommunicable and communicable disease.

  • Noncommunicable Disease (NCD):

    • More commonly referred to as chronic disease.
    • Defined by the WHO (2018) as diseases that tend to be of long duration and are the result of a combination of genetic, physiological, environmental, and behavioral factors.
    • The main types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes.

  • Communicable Diseases:

    • Defined as an infectious disease that is passed from person to person through direct contact with an infected individual.
    • Include life-threatening viruses such as Zika and Ebola, seasonal influenza viruses (flu and colds), or Lyme disease.
    • Most are preventable through proper hygiene, vaccinations, and taking necessary precautions.
    • If exposure is suspected and symptoms of an infection develop, medical attention should be sought immediately.

  • Food for Thought:

    • Noncommunicable diseases, or NCDs, are by far the leading cause of death in the world, representing 71% of all annual deaths.
    • NCDs kill more than 41 million people each year.
    • Some 85% of all NCD deaths occur in low- and middle-income countries (WHO, 2018).

Coronary Artery Disease

  • The leading cause of death in both men and women (CDC, 2013).
  • Preventative efforts and the availability of better treatments have lowered the rates of death from NCDs in the past few decades.
  • The top two preventable causes can be contributed to cigarette smoking, physical inactivity, and/or poor diet (Mokdad, 2004).

Wellness

  • Encompasses numerous components of life that dynamically lead to a better state of health and wellbeing.
  • The National Wellness Institute (2018) addresses six dimensions of wellness in their definition:
    • Emotional, occupational, physical, social, intellectual, and spiritual.
    • Addressing all six dimensions of wellness in our lives builds a holistic sense of wellness and fulfillment.

Wellness vs. Health

  • Wellness is a fluid process, whereas health is often viewed in objective terms of good or bad.
  • Health is a state of being, underscored by the absence or presence of chronic conditions and disease.
  • Wellness exists on a more dynamic continuum (Figure: The Illness–Wellness Continuum) (Travis & Ryan, 2004).
  • A person’s health refers to their objective states of physical, mental, and social well-being, whereas wellness encompasses the lifestyle practices aimed to enhance those objective states.
  • Wellness views health from a holistic perspective (mind, body, and spirit).

Dimensions of Wellness

  • Emotional wellness inspires a sense of inner calm, relaxation, and inner strength.
    • Practices remind us to stay positive, smile, be mindful, learn from mistakes, ask for help from others, and remember that life is full of peaks and valleys.
    • Both positive and negative emotions affect how we respond and adapt to our surroundings. This is especially true in relation to eating habits and maintaining a healthy relationship with food.
  • Occupational wellness encourages us to carefully consider our career and employment opportunities throughout our lifetime.
    • Personal satisfaction and senses of purpose and value are factors that lead to a high level of occupational wellness.
    • Enhancing occupational wellness does not necessarily require monetary compensation. Taking time to explore volunteer opportunities that allow people to focus on tasks and skills they enjoy will lead to a greater sense of fulfillment and increase to overall occupational wellness.
  • Physical wellness encompasses a sense of respect and responsibility for taking care of our bodies, promoting a desired sense of optimal health and physical functioning across the lifespan.
    • Overall physical wellness encourages the balance of physical activity, exercise, rest and relaxation, nutrition, mental health, and well-being.
    • Maintaining an optimal level of physical wellness directly leads to better health.
  • Social wellness refers to our ability to form and maintain relationships with others.
    • Isolation can lead to negative emotions, whereas a robust social network helps develop a positive outlook on life, especially when life is challenging.
    • Learning to build healthy, nurturing, and supportive relationships with others leads to a high degree of social wellness. Improving social wellness is one of the best ways to also improve emotional wellness.
  • Intellectual wellness encourages people to never stop learning and engaging in creative and mentally stimulating activities across the lifespan.
    • It means participating in activities that expand knowledge and skills across academic, cultural, community, and personal pursuits.
    • Intellectual wellness fosters a greater sense of fulfillment and helps improve both emotional and occupational wellness for a more balanced life.
  • Spiritual wellness is often one of the least understood wellness components.
    • Being spiritual simply means having personal faith in something that deepens feelings of belonging and peace with oneself and the world.
    • A person’s spiritual wellness can be defined in terms of religious faith, personal values, ethical/moral beliefs, or simply a general acceptance of an underlying mind-body-spirit connection. At its core, it helps create a greater sense of meaning and purpose in life and enhances all other dimensions of wellness.

The Role of Diet in Chronic Disease

  • The association between diet and disease has been investigated and reported for thousands of years.
  • The Greek physician and “father of modern medicine,” Hippocrates (460–370 BC), was perhaps one of the first scientists to recognize the connection between diet and health:
    • "If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health. Let food be thy medicine and medicine be thy food".
  • Nutrition Coaches should be concerned with how diet relates to the most common chronic disease conditions in the United States and worldwide.

Obesity

  • According to the Centers for Disease Control (CDC), 40% of American adults were obese in 2016; this represents 93.3 million adults (Hales, 2017).

  • Obesity-related conditions including heart disease, stroke, Type 2 diabetes, and certain types of cancer are the leading causes of preventable, premature death (National Heart, Lung, and Blood Institute, 2013).

  • The link between diet and obesity is studied by looking at the dietary patterns (including total caloric intake and diet quality) and biometrics of large groups of people and then determining if any associations exist (Min, 2017).

    There is a direct association between diet, obesity, body fat, and body mass index (BMI).
    Studies support a balanced diet that is associated with lower rates of being overweight or obese.
    The risk of developing obesity (and its associated chronic conditions) is the highest in those that eat a diet high in saturated fat and total calories (referred to as a Western pattern diet).
    Higher total caloric intake each day paired with low energy expenditure is directly associated with a higher incidence of being overweight or obese.
    A change in dietary habits can play a significant role in reversing obesity.

  • Heart Disease Diet is considered an independent modifiable risk factor for coronary artery disease.

    • The higher a diet is in saturated fat and cholesterol, the higher the risk of developing heart disease, independent of all other risk factors (Nettleton, 2017).
    • There is a strong correlation between reduced risk of developing heart disease and choosing a diet low in saturated fat, high in fiber, low in salt and sugar, and high in plant foods (Mente, 2009).
    • Additional risk factors for heart disease include obesity, high blood pressure, and uncontrolled diabetes.

  • The Mayo Clinic (2018) offers the following heart-healthy dietary recommendations:

    Choose a diet that is low in saturated fat and aims to remove all trans fats.
    Follow guidelines specifically for health conditions; for example, guidelines set by the American Heart Association or the World Health Organization.
    Choose beverages and foods that are low in added sugar.
    Eat plenty of fresh fruit and vegetables.
    Reduce intake of fatty meats, processed foods, and foods with high salt content.
    If you drink alcohol, do so in moderation.
    Control portion size.
    Eat more whole grains.
    Limit unhealthy fats (no more than 5 to 6% of total calories from saturated fat and NO trans fat); monounsaturated fats (olive oil) are preferred.
    Choose low-fat protein sources such as fish, legumes, lean meat, and low-fat dairy products.
    Reduce sodium intake (no more than 1,500 mg of sodium per day).
    Plan and create menus ahead of time.
    Treat yourself on occasion.

Cancer

  • Shown that diet can directly affect cancer risk (Song, 2016).

    • Highly processed foods, red meat, and salt-preserved foods have been shown to increase the risk of developing cancer.
    • A health-supporting diet including fresh fruits, vegetables, and foods high in fiber has been shown to reduce the risk of cancer.

  • Factors that increase one’s risk for developing cancer, including genetics and the environment, typically only amount to less than 30% of a person's lifetime risk of getting cancer.

    • The majority of steps to prevent Steps to prevent cancer are controllable, including diet.

  • Dietary habits associated with a lower incidence of cancer rates (Miller, 1990):

    Eating foods high in antioxidants (foods that are bright in colors, such as dark green, orange, purple, and red fruits and vegetable such as spinach, carrots, and tomatoes)
    Eating low glycemic index (GI) foods – Consuming foods with a high GI is associated with a significantly greater risk of certain types of cancer.
    Increasing dietary calcium intake – There is strong evidence to suggest that higher calcium intake can help reduce the risk of cancer.
    Maintaining a low BMI – A higher body mass index increases the risk of developing some of the most common cancers.

Diabetes

-The link between Type 2 diabetes and diet is very strong (Sami, 2017).
-The strongest risk factor for Type 2 diabetes is obesity, which is also strongly correlated with dietary habits.
-Rapid and significant weight gain and the consumption of high amounts of added sugar in food and drinks are major factors in developing Type 2 diabetes.
-A diet low in added sugar and total calories is highly recommended for preventing Type-2 diabetes (Gray, 2015).

Socio-Cultural Factors

  • Play a significant role in the development of food preferences across the lifespan.

  • For some cultures, the preparation, serving, and consumption of food is a complex social and personal experience.

  • From growing and harvesting food to preparing and celebrating meals together, food preferences and behaviors are learned early on and persist throughout life (Smith, 2016).

  • For others, food choices and dietary behaviors have little social context; instead, it is just a means of eating for survival.

  • Both positive and negative social influences can be linked to emotional eating and may lead to eating disorders and obesity (Bongers & Jansen, 2016).

  • Cultural influences can have both a significant impact on health, nutrition, and long-term health risks.

  • Income inequality, limited access to healthy foods, exercise habits, and rapidly changing cultural shifts due to increased globalization can all have an impact of diet choices and both short- and long-term health outcomes.

  • Diets that stress lower-saturated fat foods and more fresh fruits and vegetables have proven advantages but may, in fact, be limited in some cultures due to cultural preferences, social class, and income inequality. Religion also influences food selection.

    • For example, Seventh Day Adventists promote a vegan diet, while traditional Catholics often avoid meat on Fridays.

  • Examples of the diversity of religions’ food preferences include the following:

    Muslims who typically eat Halal (religiously lawful) foods, consisting of fruit, vegetables, eggs, and meat farmed, slaughtered, and prepared under strict criteria.
    Hindus who are primarily lacto-vegetarian (avoiding most meat and eggs).
    Sikhs who are also primarily vegetarian.
    Jews who often follow Kosher dietary practices that are similar to Halal traditions.

  • Social Food Preferences Examples:

    Meals during holidays like American Thanksgiving are focused more on the social experience rather than the health effects of the meal itself.
    The average American consumes around 3,000 calories on Thanksgiving just for dinner alone. After accounting for breakfast, snacks, drinks, dessert, and appetizers, the total calorie count for the day can easily exceed 5,000 calories or more!
    Athletes may also have unique dietary practices within the culture of their sport.
    And some families enjoy nearly all of their meals together, which helps to build the strength and unity of the family unit as well.

Age

  • Dietary habits may change as Metabolisms slow and less energy is expended over the course of the day. As people age, they tend to need fewer calories to survive (Figure: Change in Metabolic Rate With Age) (Shimokata, 1993).

  • The secret to maintaining a healthy weight as we age is to eat a health-supporting diet throughout the lifespan and respond and adapt to change.

  • A poor diet is common among older people, mostly due to changing economic and social conditions, such as the loss of a spouse.

  • Even with slower metabolisms in later stages of life, it is still important for everyone to eat a balanced diet that includes all necessary vitamins and minerals for the appropriate life stage.

  • Older adults tend to have lower dietary intake of certain vitamins and minerals, like calcium, iron, zinc, B vitamins, and vitamin E, which could accelerate diet-related illnesses or health problems (Drewnowski & Shultz, 2001).

  • Physiological changes that impact food preferences later in life:

    The emptying of the stomach
    Altered hormonal responses
    Slowing metabolism
    Changes to taste and smell
    Lower physical activity all impact our food preferences later in life.

  • Older adults should be encouraged to consume less energy-dense sweets and fast foods and choose a diet high in whole grains, lean protein, healthy fats, vegetables, and fruits.

  • Other factors, such as marital status, income, education, and socio-economic status, likely play a role in changes to food preferences and food selection as people get older (Weindruch & Sohal, 1997).

Economic Status

  • Of all the variables contributing to food choices, economic status likely plays an important role (European Food Information Council, 2004).
  • Economics is directly tied to food choices Individuals living in poverty generally develop poor eating habits simply out of a need to survive (De Irala-Estevez, 2000).
  • High-calorie, highly processed foods are cheap and widely available, and often the availability of grocery stores in economically depressed areas is limited (Figure: Convenience Store). These areas are known as food deserts.
  • The access to fresh, inexpensive foods in highly impoverished neighborhoods is nearly nonexistent and a continually growing problem in the United States.
  • By comparison, wealthier communities will have access to a wide range of supermarket and speciality store options, making it much easier for people to optomize their nutrition (Figure: Suburban Supermarket).
  • There is a direct correlation between lower socio-economic status and increased risk of the development of chronic diseases such as obesity, heart disease, and diabetes (Cockerham, Hamby & Oates, 2017).
  • A lack of financial resources leads to greater food insecurity, which typically results in both short-term and long-term effects on the health and well-being of children and adults across the lifespan.
  • Wealth does allow for better access to healthier and more secure food choices; of course, it is up to the individual to determine how they spend their resources.

Geographical & Seasonal Availability

  • Play a significant role in food selection, as well.
  • The farther someone lives from the farms that make their food, the more work it takes to get it to their table.
  • As seasons change, so do cravings because of the global economy, most foods are available year-round, though maybe just not locally sourced.
  • Availability of certain foods, especially fresh foods, is dependent on a complex infrastructure of farmers, shippers, and retail establishments.
  • Studies have shown a correlation between access to healthful food and various geographical locations (The Food Trust, 2010).
  • Also tend to prefer certain foods over others based on the season. Weather and seasonal influences can impact why certain foods are desired, like hot chocolate in the winter and ice-cold lemonade in the summer.
  • Studies have shown that certain foods such as soups, vegetables, and dark leafy greens are preferred in winter months, while citrus fruits and colorful vegetables are preferred in warmer months (Slavin & Lloyd, 2012).

Biological Influences

  • Are highly dependent on complex biological structure. Hunger, appetite, and taste are central driving forces that regulate food choices; however, these factors are regulated by complex biological, neuro-chemical, and physiological mechanisms.

  • Biological determinants such as hunger, appetite, taste, allergies, and intolerances to foods may influence food choices and result in the inclusion or exclusion of certain foods (e.g., celiac disease, nut or shellfish allergy, lactose intolerance, etc.).

  • Satiety:

    • A multi-factor theory. Food satiety signaling is complex and influenced by cognitive, sensory, and physiological responses.
    • Consuming high portions of protein and complex carbohydrates tends to inspire high-satiety responses, whereas fat has the lowest satiety-signal response (Chambers, McCrickerd & Yeomans, 2015).
    • Satiety is induced via a number of mechanisms (Figure: Satiety Signaling Response) (Blundell et al., 2012). These include gastric distension, the gut hormone CCK, and the energy density of food consumed.
    • Eating larger portions of high-fat, calorically dense food before the brain and stomach connect to signal that enough calories have been consumed.
    • Foods high in protein and fiber tend to have stronger satiety sensations, making them highly beneficial for balanced weight management.
    • Slower paced eating is associated with improved satiety and gut hormone responses in normal-weight participants.
    • Slower-paced eating increased fullness and decreased hunger in all three groups (Angelopoulos, 2014). With that in mind, slow-paced eating can be a beneficial intervention in the fight to curb the obesity and diabetes epidemic by first increasing the sensation of fullness.

  • Sensory Stimuli:

    • Appetite can be triggered by thoughts, emotions, mood, sight, smell, and proximity of food (McCrickerd & Forde, 2016).
    • Location, taste, texture, smells, and past experiences all play a role in when, how much, and how often selected foods are consumed (McCrickerd & Forde, 2016).
    • Low energy stores, a low blood sugar level, and an empty, growling stomach are also powerful forces that stimulate hunger (Wright, 2008). Going grocery shopping or out to eat should be planned around having adequate energy balance in order to make healthy food choices that are not heavily driven by those sensory stimuli (Wright, 2008).
    • Nutrition Coaches play an important role in educating clients on how to be aware of food stimuli cues and how to develop coping skills when faced with unhealthy food temptations.

Health, Wellness, and Disease

  • The success of personalized nutrition relies on the ability to integrate the scientific approach with everyday cultural, emotional, ethical, and sensual understandings of food.

This chapter taught:

Definitions of health, wellness, and disease.
The spectrum of health, ranging from pathology to optimal well-being.
The six dimensions of wellness and how they impact individual health and quality of life.
Chronic diseases and their impact on mortality for the population.
The cultural, geographical, and sensory influences that determine food preferences.
Being respectful of food traditions from all around the world.
How to keep nutrition plans individualized and flexible.