Tuesday, December 12, 2006

Ethos of food: How the Food Guide Pyramid fails to account for the social context of the eating experience in American adolescents. -Sabrina Khouri

The first food composition table used for general nutrition guidance was developed in 1894 by W.O. Altwater, a pioneer in nutrition investigation. The first Food Guide Pyramid (FGP) was developed by the ¬United States Department of Agriculture (USDA) in 1916, and was one of eight versions to date (USDA, 1993). By 1992, the United States had been plagued with a condition that knew no demographic boundaries for two decades. The 1992 version, the seventh of the eight pyramids, was heavily marketed in response to the obesity epidemic in the U.S. The eight philosophical goals that the USDA incorporated in the development of the FGP were to promote overall health, to be research-based, to represent a total diet, to evolve from previous guides, and to be useful, realistic, flexible, and practical (USDA, 1993). Essentially, the purpose of the FGP was to provide individuals with visual guidelines for balanced nutrition in an effort to reduce the burden of obesity in the U.S. According to the NHANES III Survey (1988-1994), conducted around the time the 1992 FGP was developed, the prevalence of overweight in U.S. adolescents ages 12-19 was 10.5% (CDC). The 2003-2004 NHANES Survey reports adolescent overweight to be 17.4% (CDC). The 6.9% increase in the prevalence of obesity in a decade clearly demonstrates that the FGP has failed its mission to reduce the burden of obesity in the United States. The Food Guide Pyramid failed to curtail obesity for 3 reasons: it does not consider the social context of eating as outlined by the Social Cognitive Theory, the social facilitation effect and the time extension effect; it has a “one size fits all” approach; and it does not address self-efficacy.

The FGP succeeded in educating the public about the ideal diet. The FGP was marketed aggressively by introducing it to youth in schools. The USDA’s Food and Nutrition Information Center created training materials for teachers and educational materials for students, which were used in schools as part of the health curriculum (USDA, 2001). A consumer survey conducted by an independent research company called StrategyOne shows that 60% of Americans are extremely familiar with the FGP (National Dairy Council, 2004). In terms of visibility, the FGP had a tremendously successful campaign.

As far as eliciting behavior change, the FGP has failed. The StrategyOne consumer survey also shows that 60% of Americans will not employ the FGP at all when making food choices (National Dairy Council, 2004). Therefore, familiarity with the tool does not dictate its use. The failure of the FGP is in its individualistic approach to obesity without ever considering the social context of eating behaviors. The FGP assumes that food choices are rational, educated decisions made on an individual level.

The social context in which eating takes place is never considered by the FGP as the primary factor in making food choices. Most social celebrations have come to include eating as a central activity. Birthdays, anniversaries, graduations, religious holidays, weddings are all keystone events that link food and celebration. The pleasure of good company and celebration becomes associated with overindulgence. Moderation is not a social norm at celebratory events. Memories of eating, particularly positive memories, can affect a person’s perception of food for a lifetime.
The social environment in which eating takes place can also drive the type and amount of food consumed by an individual. According to the social facilitation effect, “people eat more as the number of co-eaters increases” because meals with increased number of members last longer and people eat more during long meals (Pliner, 2006). Neither the social facilitation effect nor the time extension effect is ever mentioned in the FGP.

According to Albert Bandura’s Social Cognitive Theory, human behaviors are a result of the dynamic interaction of three factors: environmental, personal and behavioral (Pajares, 2002). Environmental factors are defined as societal structures. Personal factors deal with the person’s emotional state, their self-beliefs and their habits. Behavioral factors include the behaviors themselves and the tools used to perform those behaviors. The interaction of these factors results in a triadic reciprocality, any one of the factors can be the result or the cause of any of the other factors (Pajares, 2002). For example, a person’s perception of their own behavior can alter their emotional state and their environment and, conversely, a person’s environment can influence their emotional state and their behavior. This reciprocal determinism is the basis for Bandura’s argument that effective behavioral intervention addresses all three factors (Pajares, 2002).

Though the FGP is an excellent visual representation of a hierarchy of foods that people should be consuming, it does not provide the tools to address personal, environmental or behavioral factors associated with food choices. Instead, it divulges information about the “ideal” healthy diet. The FGP assumes that people are making poor food choices due to a lack of knowledge of healthful foods. Emotional effects on food choices are numerous and are a strong determinant of food choices. Some people use food as an emotional ‘crutch’, consuming their favorite foods in search of an instantly gratifying feeling to draw attention away from emotional distress. Biologically, this sense of gratification results from the release of beta-endorphins (an opiate neurotransmitter) when thinking about or consuming food cause a physiological experience of pleasure (Insel, 2002). This biological reward for food consumption can be a significant drive for behavior. Food choices can also be influenced by emotional ties that people have to certain foods. For example, food that was used as a reward during childhood are often associated with positive emotions for a lifetime. Conversely, negative emotions can be associated with foods as well, preventing people from consuming certain foods (Insel, 2002).

Moreover, the FGP fails to address the environmental component of the triadic reciprocality. Lack of access to grocery stores that have a variety of high quality foods at a reasonable cost can limit an individual’s ability to follow suggestions provided by the FGP. Another crucial environmental factor that is not mentioned in the FGP is the effect of culture on food choices. Also, geographical location can affect the types of produce available and the seasons in which it is available. For example, someone who lives in Florida has more citrus fruit available than someone living in North Dakota leading to greater vitamin C consumption by the Floridian. Another important environmental factor is culture. Cultural background, including religious practices, can affect meal time, duration, how much is consumed, how meals are prepared, rituals that surround eating and the frequency of foods consumed. For example, Buddhism, a predominant religion in Asians, has five core ethics called Sila (Jen). The First Sila is “do not kill”, therefore many Buddhists are vegetarian (Jen). Buddhists may get most of their protein intake from tofu, nuts, beans and dairy products. The FGP does not directly address these different lifestyles and may imply that these religious practices are nutritionally deviant.
Finally, behavior changes are implied in the FGP, but people’s perception of their behaviors is never addressed. If someone perceives their diet to be healthy even though it may not be healthy according to the FGP, the likelihood of diet change is minimal. If someone perceives their diet to be unhealthy, as defined by the FGP, but they perceive the benefits of the pleasure they derive from food to outweigh the risks that result from over consumption, the likelihood of diet change is also minimal.

The FGP fails to address self-efficacy. Self-efficacy is a person’s belief in their own capabilities (Pajares, 2002). Bandura argued that “people’s level of motivation, affective states, and actions are based more on what they believe than on what is objectively true”. For many behaviors, self-efficacy is often the divide between intention and actually performing a behavior. Swedish scientists, Elfhang and Rossner, investigated the effect of self-efficacy on weight loss maintenance and found that “weight maintainers have also shown that they have more confidence in the ability to manage the weight than the weight regainers”. High level of self-efficacy was associated with long-term maintenance of weight loss (Elfhang, 2005).

In order for the FGP to be effective people have to believe that they are able to follow the guidelines suggested. The FGP provides no motivation for people to alter their behavior. The question becomes: Why should people change their eating habits, which have been shaped by their culture, environment, views of pleasure and coping mechanisms, when they may not even believe that they can change their behavior?

The impact of self-efficacy on public health campaigns can be noted in issues such as smoking and practicing safe sex. Information is readily available describing increased risk of various cancers, heart disease, and pulmonary disease in smokers yet smoking cessation has a 97% failure rate (Connolly, 2000). Using contraceptives can prevent pregnancy and the transmission of a myriad of possibly life-threatening diseases, yet 11% of fertile, sexually active women who do not want to become pregnant do not use contraception (Guttmacher Institute, 2005). Is the immediate gratification of risky behavior worth the risk, or have public health campaigns failed to motivate people by ignoring self-efficacy? Education alone is a public health favorite and a public health failure.

When the FGP was revised in 2005, the pyramidal shape was retained and a physical activity component was incorporated. According to the new FGP, healthy behavior is achieved not only by changing eating behavior but also adding daily physical activity. 60% of Americans did not use the 1992 FGP to make food choices, what would motivate Americans to incorporate the 2005 FGP which adds physical activity and continues to disregard social issues?

Although, the 2005 FGP incorporates the need for assessing individual nutritional requirements, it assumes that people will go to the website, enter their personal information, and assess their personal needs. This approach, immediately excludes individuals of lower socioeconomic status that may not have access to the internet. The actual pyramid implies a “one size fits all” approach, which is inconsistent with nutrition principles. Nutritionists use equations to incorporate weight, height, gender and age to calculate individual nutritional needs (Insel, 2002). The caloric needs of a middle aged woman that is 5’4” and weighs 125 lbs are markedly different from those of a 17 year old male that is 6’2” and weighs 200 lbs.
Both the 1992 and 2005 FGPs achieve the goal of exposing the public to nutritional recommendations; however a majority of Americans do not use this knowledge in making food choices. Without considering the social context of food choices, self-efficacy and individual nutritional needs, the FGP is a poor nutritional intervention and will be unsuccessful in eliciting behavioral change.

References
Centers for Disease Control and Prevention. (n.d.). Trends in Childhood Overweight. Retrieved December 2, 2006, from http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/prevalence.htm.

Connolly, Martin J. (2000). Smoking cessation in old age: closing the stable door? Age and Aging, 29, 193-195. Retrieved December 3, 2006 from http://ageing.oxfordjournals.org/cgi/reprint/29/3/193.pdf.

Elfhang, K. and Rossner, S. (2005, February). Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obesity Reviews, 6, 67. Retrieved December 5, 2006, from
http://www.blackwell-synergy.com/doi/full/10.1111/j.1467-789X.2005.00170.x?prevSearch=allfield%3A%28self-efficacy%29.

Guttmacher Institute. (2005, March). Contraceptive Use. Retrieved December 3, 2006, from http://www.guttmacher.org/pubs/fb_contr_use.html

Insel, P., Turner, R.E., & Ross, D. (2002). Nutrition. Sadbury, MA: Jones and Bartlett Publishers, Inc.

Jen, Ting. (n.d.). Religion and Vegetarianism: A Buddhist View of Vegetarianism. Retrieved December 5, 2006, from http://www.ivu.org/religion/articles/kvmi.html.

National Dairy Council. (2004, August). Notice of Proposal for Food Guide Graphic
Presentation and Consumer Education Materials; Opportunity for Public Comment. (FR
Docket No. 04-15710). Alexandria, VA: Food Guide Pyramid Reassessment Team.

Pajares (2002). Overview of social cognitive theory and of self-efficacy. Retrived October 10, 2006, from http://www.emory.edu/EDUCATION/mfp/eff.html.

Pliner, P., Bell, R., Hirsch, E.S., & Kinchla, M. (2006). Meal duration mediates the effect of “social facilitation” on eating in humans. Appetite, 46, 189-198. Retrieved October 18, 2006, from ScienceDirect.

United States Department of Agriculture. (2001, May). Food and Nutrition Resources for Grade 7-12. (Special Reference Briefs Series no. 2001-01). Beltsville, MD: National Agriculture Library, Food and Nutrition Information Center.

United States Department of Agriculture. (1993, September). USDA’s Food Guide Background and Development. (Miscellaneous Publication Number 1514). Hyattsville, MD: Human Nutrition Information Service.

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