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Childhood obesity on the rise in Vietnam

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Childhood obesity on the rise in Vietnam

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Imbalanced nutrition prompts increase of childhood obesity in Vietnam.

Obesity rates are ballooning in Vietnam's big cities as malnourishment persists in the provinces, according to Professor Le Thi Hop of the National Nutrition Institute.

"Vietnam is one of 20 countries reporting the highest proportion of underweight children in the world. Meanwhile, about 1.2 million children here suffer from obesity," she said during the Ho Chi Minh City Nutrition Conference on August 1.

"This poses challenges to the National Nutrion Strategy for 2011-2020 period," she said.

According to a study released at the conference, the number of obese children under five in HCMC has increased three-fold over the past decade from 3.7 percent in 2000 to 11.5 percent in 2013.

The study blamed poor diet (i.e. too much protein and fat and too few vitamins and minerals), unstable meal times and a lack of physical exercise.

Meanwhile, Hop said the whole country suffers from a nutritional imbalance, noting that the majority of underweight children live in rural and mountainous areas.

"Up to 40 percent of children in Lao Cai and Kon Tum provinces are uderweight, this is a very high proportion," she quoted a recent survey as saying

Dr Huynh Hanh of the University of British Columbia said the opening of fastfood chains in Vietnam is another major cause of obesity in Vietnam.

"Generally, obesity is influenced by the interplay of biological, behavioral and environmental factors," he said.

According to Hanh, urban areas have been strongly influenced by nutritional transitions caused by a rise in the consumption of ultra-processed food products like burgers, soft drinks and simultaneous a drop in the consumption of fruits,vegetables and milk.

"Over the course of more than fifty years, various campaigns to influence the diets and exercise regimens of the population have failed to significantly modify the majority's habits," he said, stressing the importance of raising awareness about obesity.

Dr Do Thi Ngoc Diep, director of the HCMC Nutrition Institute, stressed the role of schools in tackling obesity among children; the city has 1.5 million students, more than third of whom are eat breakfast and lunch at school and only return home after afternoon tutoring sessions.

"Obesity has become a major problem in HCMC. It is also common among women of prime child-bearing age," she said.

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Childhood obesity on the rise in Vietnam

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Imbalanced nutrition prompts increase of childhood obesity in Vietnam. Obesity rates are ballooning in Vietnam's big cities as malnourishment persists in the provinces, according to Professor Le Thi Hop of the National Nutrition Institute. "Vietnam is one of 20 countries reporting the highest proportion of underweight children in the world.

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Soybeans, salmon, chocolate…are healthy foods recommended by experts if you want to have a strong heart.

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15 Names of Best Food in Vietnam!

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Vina.com represents all things about Vietnam

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In the past, Tue Tinh, Hai Thuong Lan Ong - the two famous Vietnamese physicians emphasized the important role of food in preventing and treating some certain diseases. The reality has proven that nutrition has huge impacts to human health. The main goal of eating food is to feed your body nutrients, nurture organs and improve the whole human health system. However, eating is actually an art and people also need to realize and be aware clearly of some other meanings of eating, such as to express the attachment and the love between children and parents; to represent the traditional culture of the country and comunity. This article will help you understand more about the cultural and the nutritional quality of Vietnamese food. Actually, you will have the exact answer for the question: is Vietnamese food healthy, and also catch some Vietnamese food names which are really healthy for human beings.

I. The Fact Of Vietnamese Food & Is Vietnamese Food Healthy?

1. Vietnamese Food Culture History And The Current Situation:

In recent years, the food culture has become an important factor in the tourism development. In this context, the issue of exploitating the Vietnam's culinary to promote tourism and attract tourists is what the management agencies pespecially interest in the most.

In the trend that the tourism demands are very diversified, food and cuisine not only acts as a support element, merely serves the eating needs and requirements of customers, but it has become the purpose of the travel holders and agencies.

In fact, many travel agencies in the world have organized some culinary tourism programs with the major aim is to serve the needs of the tourists in enjoying the special traditional food taste in the tourist destinations.

Stemming from that reason, in recent years, food culture has become one of the factors which are exploited and used in promotional activities to attract tourists. However, there is a fact that the current use of food elements to organize promotional activities to attract international tourists drags on several issues which are need to be modified and improved to better suit the needs and response the tourism promotion activities more effectively.

Based on many extensive researches and the awareness of the current tourism's situation as well as the promotion activities, the goal of this article is referring to the role of food culture in the field of tourism promotion and threading export-oriented and solution to exploit the values of Vietnamese food culture in order to attract international tourists.

Vietnamese cuisine has its own features depending on the culinary of the North, Central and South regions. Each region has specific dishes affected people's habits and plentiful natural conditions, creating the cultural diversity of the whole country's cuisine.

Vietnam's food culture was formed and developed in the association with the development of the whole society. Vietnamese food today has undergone long-term development of the national history, so it is very diverse and harmonious. There are pure Vietnamese dishes, and there are also dishes influenced by Chinese food culture, French food culture, and even Indian food culture.

Due to the trade between countries, Vietnam cuisine is influenced by the cooking methods of India with characteristic spices and typical dishes. The historical period of nearly 1,000 years under China showed that not only Vietnamese pople's writing but also their eating habits and cooking methods are affected by China, creating a system of foods which carry some features of the Chinese cuisine. Besides, with nearly 100 years under French colonial rule, Vietnam cuisine is also influenced greatly by the typical cooking methods of French people with many kinds of sauce and broth.

In the current time period, in the context of deep globalization and international economic integration, Vietnamese food culture has a lot of favorable conditions for its continuous development and growth.

2. Is Vietnamese Food Healthy? - Some Of The Best Benefits Of Vietnamese Food:

Vietnamese food is not only tasty, but also very good for human health.

Vietnamese dishes are gluten-free, really low in fat, and jam-packed with a lot of healthy and necessary minerals and vitamins, which are perfect for human beings to boost the immune system, lose extra weight, and provide our own body the energy it needs.

- Is Vietnamese Food Healthy? - Aiding The Weight Loss Process:

Eating Vietnamese food will help to cut calories and you will eat less fat because instead of oil or dairy, Vietnamese dishes is flavoured with many kinds of spices and herbs and is jam-packed with fresh vegetables and fruits. Most Vietnamese dressings, authentic dishes, and sauces you will find in restaurants are very low in fat and calories. Even a giant bowl of Vietnamese noodle soup ("Pho") just provides 300 to 600 calories, and contains less than 3 grams of fat per serving, meaning that you can eat one bowl of Pho every day for dinner or for lunch as part of a low-fat, calorie controlled diet.

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Is Vietnamese food healthy? 15 names of best food in Vietnam!

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In the past, Tue Tinh, Hai Thuong Lan Ong - the two famous Vietnamese physicians emphasized the important role of food in preventing and treating some certain diseases. The reality has proven that nutrition has huge impacts to human health.

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Seven Reasons Why You Should Start Eating Vietnamese Food

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Not only is Vietnamese food delicious, but it is also really healthy.

Low in fat, gluten-free and jam-packed with vitamins and minerals, it is the perfect food to boost your immune system, aid weight loss and give your energy. (And it's pretty good at soaking up a hangover.)

We caught up with health-conscious restaurant Pho to find out seven reasons why we should all be eating more Vietnamese food.

1. To keep you looking young...
With antioxidants that delay ageing. Vietnamese salads and soups are full of Vitamins E and A, thanks to fresh herbs, spices, plenty of veg and lean protein.

Vitamin E works to fight free radicals in your body (one of the major causes of pre mature ageing) and Vitamin A is essential for healing scrapes and scars, and keeping wrinkles at bay.
2. To boost your immune system and fight fatigue...
With a loads of your daily Vitamins and minerals, in one bowl. Authentic Vietnamese stocks take 10+ hours to prepare, and are a great source of 10 of your vitamins and minerals including vitamins C, B3, B6, folate, iron and magnesium - nutrients which all contribute to the reduction of tiredness.

Vietnamese salads stack up as well: the Prawn Papaya Salad at Pho contains more than 50% of your daily recommended intake of Vitamin C as well as Vitamins B1, B6, B3, folate, biotin, zinc, copper, magnesium and potassium. With only 200 calories and less than 2g of fat per serving, that's what we call it a "superfood" salad.
3. To regulate blood sugar...
By eating less wheat. Refined grain products get digested quickly, which can lead to a large spike in blood sugar, followed by an even larger drop, making you hungrier, faster.

Vietnamese food is almost always naturally gluten-free, as many of the dishes are made with rice noodles, rice papers and rice flour instead of wheat. A small amount of Vietnamese food is made with soy sauce, but even that can be substituted with a gluten-free option.

See Also: Vietnamese Recipes: Stir-Fried Udon, Caramelised Sardines And Avocado Ice Cream Delicious and Healthy: Vietnamese Pho With Turkey and Rice Noodles
4. To improve your digestion...
With restorative herbs like coriander and mint. Not only are most Vietnamese dishes flavoured with fresh herbs, but each bowl of authentic pho comes with a massive side plate of herbs to add to your soup as you wish. On every classic pho herb plate you'll find coriander and fresh mint - two herbs that are known to promote healthy functioning of the liver as well as relief from indigestion and nausea (and headaches!).
5. For strong, healthy hair...
From iron, protein and Vitamin C. Eating plenty of iron and lean protein is pertinent to hair growth and maintaining strong, healthy locks. What's more? Vitamin C aids the absorption of iron, so eating dishes like Vietnamese stir-

fries or bun noodles (packed with lean protein and plenty of veggies) will double the pleasure.
6. To avoid sugar...
...because we're all supposed to do that in 2014. Earlier this year, health experts warned us that sugar is just as dangerous as alcohol and tobacco. Many Vietnamese soups and starters like fresh spring and summer rolls are low in sugar (less than 5g per serving). Eating Vietnamese food often will certainly help cut the intake of sugar each week.
7. To lose weight...
By cutting calories and eating less fat. Because Vietnamese food is flavoured with herbs and spices (instead of oil or dairy) and is packed full of fresh fruit and vegetables, most authentic dishes, dressings and sauces you'll find in restaurants are low in calories and fat. Giant bowls of pho noodle soups have between 300 and 600 calories each, and less than 3g of fat per serving, which means you could eat one every day for lunch or dinner as part of a calorie controlled, low-fat diet.
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Healthy Eating: Seven Reasons Why You Should Start Eating Vietnamese Food

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Not only is Vietnamese food delicious, but it is also really healthy. Low in fat, gluten-free and jam-packed with vitamins and minerals, it is the perfect food to boost your immune system, aid weight loss and give your energy. (And it's pretty good at soaking up a hangover.)

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Other countries people are fatter than Vietnamese

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The number of obese adults in the ASEAN Six increased at a faster rate than that of the United Kingdom and the United States of America from 2010 to 2014, according to data gathered by the Economist Intelligence Unit ( EIU).

This statistic was one among several key figures on obesity and its economic impact, highlighted in an inception report on "The Current Landscape and State of Health in Relation to Obesity in South-East Asia", prepared by the EIU for a study commissioned by the Asia Roundtable on Food Innovation for Improved Nutrition (ARoFIIN) and the Health Promotion Board of Singapore. Key findings from this inception report were presented to government, regulators, academia, civil society and the food industry from around the Asian region at the official launch of the study, by EIU at the recently concluded 2nd annual ARoFIIN Roundtable held in Singapore.

According to the EIU inception report, based on World Health Organization ( WHO) data, Indonesia experienced a 33 per cent increase in the number of obese individuals, while Vietnam saw a 38 per cent increase, Malaysia a 33 per cent increase and Thailand a 27 per cent increase. During this same period (2010 to 2014), the number of obese individuals in the United Kingdom and the United States of America increased by only 10 per cent and 8 per cent, respectively.

The inception study also correlated with WHO figures, which indicated that rates of obesity are rising faster in many lower- and middle-income countries, as compared to that in higher-income countries, and that childhood obesity is a particular concern in these countries.

Dr Simon Baptist, Chief Economist with the EIU, says that more evidence is needed on the economic impact of obesity in ASEAN and, importantly, which policy responses by regulators, the food industry and governments make sense in an ASEAN context.

"The current prevalence of obesity in many ASEAN countries is low by global standards-although with some exceptions for childhood obesity-but the rate is rising fast and the large populations of some countries mean that they have some of the largest numbers of overweight and obese people."

"While it is early days yet and we are just kicking off this study, initial research indicates that childhood obesity rates are growing faster in the ASEAN Six than in Japan, the UK and USA," he said.

According to Dr Baptist, the initial findings from the report show that obesity rates in the ASEAN Six are generally higher in countries with higher GDP per capita.

"Continued and rapid economic growth is therefore expected to rapidly increase the prevalence of obesity in these countries. Economic growth is typically accompanied by increased urbanisation, which provides easier access to food that is high in refined carbohydrates, saturated fat and sugar, and low in fibre - all which have been linked with obesity," says Dr Baptist.

Being overweight or obese increases an individual's risk of diseases and conditions such as heart disease or stroke, Type 2 diabetes and some cancers. The EIU inception study points to research that shows that South-East Asia is already facing an epidemic of chronic, non-communicable diseases, which now account for 60 per cent of deaths in the region.

"Obesity is shaping up to be the number one risk factor impacting health more so than infectious diseases that we in the healthcare sector worry about," says Mr Zee Yoong Kang, Chief Executive Officer, Health Promotion Board, in the official ARoFIIN launch video presented at the 2nd ARoFIIN Roundtable.

"If we do not address obesity, we'll see a huge epidemic of chronic conditions, especially diabetes. Governments (in the region) need to be aware that this would be the number one healthcare challenge that we could face over the next two to three decades," says Mr Zee.

"The Current Landscape and State of Health in Relation to Obesity in South-East Asia" report will be the first time that the economic impact of obesity will be looked at across ASEAN. The final report, which is expected to be completed at the end of October 2016, will indicate the scale of both the direct and indirect economics costs of obesity, as well as assess policy interventions, says Dr Baptist.

The Asia Roundtable on Food Innovation for Improved Nutrition (ARoFIIN) was established in January 2015, to leverage public-private partnerships and bring together experts from across government, academia, industry and civil society, to initiate and sustain a regional, multi-stakeholder dialogue on the role of food innovation in tackling obesity and chronic disease. ARoFIIN is convened by the Health Promotion Board ( HPB), the Agency for Science, Research and Technology ( A*STAR), the Singapore Institute for Clinical Sciences ( SICS) and Food Industry Asia (FIA).

FIA issues regular e-bulletins with analysis on relevant food and beverage industry issues across the region. To subscribe to this service, please click here

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South-East Asia is Getting Fatter, Faster - Food Industry Asia

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An inception report on "The Current Landscape and State of Health in Relation to Obesity in South-East Asia", by the Economist Intelligence Unit (EIU), has found that the obesity rate in the ASEAN Six is increasing faster than that of countries like the USA, UK and Japan.

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Vietnamese food is delicious

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Health - Vietnam: Aug. 27, 2018

Vietnamese food is delicious and it is often cited as one of the healthiest cuisines in the world. To make sure that this was true, we spoke to Antoine Yvon, the head nutritionist at CMI hospital in Ho Chi Minh City. You will finally know if all those banh mi sandwiches are good for you, if you should drink the broth of your pho or not, and the name of Vietnam's only super fruit. The interview was translated from French.

The health benefit of a Vietnamese food diet
City Pass Guide: What is your general professional opinion about Vietnamese food? Is it as healthy as people think it is?
Antoine: Vietnamese food is one of the most healthy and balanced in the world. As a professional, I have seen that dishes and ingredients used in Vietnamese cuisine can cover all the dietary needs on protein, lipids, carbohydrates, vitamins and minerals because there is a great natural diversity of agricultural products. It is this diversity and variety that are the foundations of a healthy and balanced lifestyle.

The way to eat food is also a very important factor that can influence the nutritional value of food. Eating with chopsticks, using multiple dishes, and sharing with people allows you to eat more slowly, to chew the food longer and in the end causes a better digestion and assimilation of nutrients, without overloading the digestive system.

Therefore, the social and cultural aspect of eating Vietnamese food is a reason why eating Vietnamese food is healthy.

The reputation of Vietnamese food as healthy is correct as long as we eat traditional dishes.

The economic growth has considerably changed the way Vietnamese people eat by bringing some Western habits and products. Modern Vietnamese eating habits are straying away from the ideals described above, with more and more processed products, enriched with artificial nutrients, artificial flavorings, rich "bad fat" (trans fat and saturated fat are not essential) and simple carbohydrates added to food, particularly all the dairy products which were unknown a few decades ago (pasteurized cheese, sweetened condensed milk, flavored yogurts) and all junk food (cakes, pastries, ice creams, sodas, fast food).

Even though Vietnam is one of the countries with the lowest rate of obesity in the world if we look at the overall population, some categories have results that are not so positive: children and teenagers. The number of Vietnamese children under five years old with weight problems has doubled in four years in Vietnam, while at the same time it has decreased by 25% in the U.S.

What Vietnamese food should be avoided? What are the healthiest options?

As long as you eat traditional food, there is not food that you should avoid. You must just make sure to avoid processed food as much as possible. It is also best to avoid deep fried food and those grilled on a barbecue.

The most healthy dishes are the soups (among which are pho), spring rolls, fruit and vegetable salads, claypot dishes, rice dishes with meat or fish cooked in sauce and fresh fruit juices.

What are the typical health problems developed by Vietnamese people from their eating habits?

The change of habits mentioned above are causing an increase in the number of cardiovascular diseases and metabolic disorders (infarctus, diabetes, metabolic syndrome), obesity, cancers, particularly among children. Also, the increased consumption of alcohol among men increases the number of liver and digestive system cancers.

The healthiest fruits in Vietnam

Is there any Vietnamese superfood (a dish or a product with superior health benefits)?
Gac is one of the healthiest fruits you can get in Vietnam. Image by Egor Kataev
Though not often eaten apart from during traditional festivities, the little know "gac" fruit (or red melon), often nicknamed the "fruit of paradise" is the fruit with the highest concentration of carotenoids in the world (a precursor to Vitamin A). The gac contains 75 times more lycopene (an antioxidant) than tomatoes. It can be considered a super fruit. Its taste is close from red melon and carrots. It is more and more popular in the U.S. or Europe as a eating supplement.

What are the most recommended local fruits and vegetables (dragonfruit, sapoche, kumquat, etc)? You might know the expression, "an apple a day keeps the doctor away" - what is the Southeast Asian equivalent of our trusted apple?

Even though there are a lot of vegetables in traditional vietnamese food, the average daily consumption is twice less than the recommendations from the World Health Organization. 40% of cancers in Vietnam are linked to food consumption (principally because of processed food, bad eating habits and bad eating hygiene). It is certain that if more fruits and vegetables were eaten, the situation could improve. Unfortunately, people are buying less fresh fruits and vegetables, because they are suspicious about the hygiene and sanitary conditions of them, and more canned products which are poorer in essential nutrients.

More important than the qualities of certain food, the most important is to eat enough and regularly the greatest variety of fruits and vegetables.

If we had to categorize them according to how rich they are in nutriments, we could differentiate:

The richest ones in vitamins and antioxidants (lychee and rambutan, chinese celery, ceylon spinach, guava, papaya, kiwi, dragon fruit)

The ones with the most sugar (to be careful with): lotus seeds, sweet potato, taro, banana, grapes, cherries, mango)

The ones that are hydrating and less sweet: berries, watermelon, melons, citruses (oranges, pomelo, lemon, kumquat), apple, star fruit, gac fruit

Dragon fruit is a tasty fruit packed full with vitamins and antioxidants!
Vietnamese are among the largest consumers of durian fruit, known for its smell more than for its qualities. It is called the king fruit here. In Indonesia, it is considered an aphrodisiac. In Vietnam, it causes several deaths every year (the mix of alcohol and durian is toxic for the liver and excessive consumption can cause hypertension).

The link between what people eat and how healthy they are is not obvious yet for many Vietnamese, which causes a lack of interest for nutrition.

Eating street food in Vietnam: Sauces, pho, banh mi, herbs...

Should we avoid Vietnamese sauces?

Sauces are a very important part of the Vietnamese food experience. A meal without sauces is like a meal without bread in France. You should not ban them.

Even the sauces that are very sweet or salty should not be banned totally. At reasonable doses, they represent only a fraction of the food intake compared to carbs like rice. Keep it simple and traditional!

Is pho healthy? Should the broth be drunk or left aside?
Pho is a healthy and balanced Vietnamese dish. Image by James
The pho, the most famous Vietnamese food, is certainly one of the most balanced dishes I know. Eaten all day long, it contains carbs, good proteins (beef or chicken), few fat, a lot of water, a lot of dietary fibers, vitamins, minerals (herbs and vegetables) and antioxidants (spices, chili, lemon). Who does not feel full after eating a Pho?

If you want to balance it even more, you can add a raw vegetable salad with vegetable oil for appetizers or a fruit salad for dessert. Add a few dry fruit too like nutmeg, peanuts, almonds.

The broth should be drunk because a lot of water-soluble vitamins and minerals are dissolved in the water during cooking. They are intact inside the broth (except for the B1 vitamin, B3 and C that are partially altered), a gold mine full of nutritive ingredients. The broth is as important as other ingredients of the pho. It is a source of water and thus hydrates and cools the body (just like nomads in the desert drink hot tea: a hot brew cools and hydrates the body better than cold water). The body reacts to hot liquids with several cooling processes (perspiration, transpiration, more efficient digestion, etc.).

Is banh mi healthy?

The banh mi is a sandwich that can be made in a multitude of ways depending on where you eat it.

More often, it contains a source of proteins (pork, chicken, ham), some vegetables (lettuce, carrots, green bean sprouts), bread and sometimes industrial soft cheese (The Laughing Cow brand).

The white bread used is not as filling as rice and noodles and is poor in good fat and fibers.

You should be careful in making sure the ingredients added are not processed food (pate, sausages, cheese) and that not too much sauce is added (particularly if it sugar, or fat).

You could replace the processed cheese with a yogurt (made of milk! It is not bad if the portion is reasonable and it can complement well a banh mi, nutritionally speaking).

Contrary to pho, the banh mi does not hydrate the body well. You can accompany it with a fresh drink while you eat such as a lime juice, coconut water or sugar cane juice.

Do the herbs added to the recipes have nutritional or health benefits (cilantro, mint, cinnamon herb, etc.)?

Aromatic herbs contain a lot of antioxidants and vitamins, whatever they are, often with a higher concentration than that found in most fruits and vegetables. It is because they smell good that they are so interesting because the aromatic molecules, the ones responsibles for the good smell, are also directly responsible for the medicinal properties of those herbs.

They have diuretic, anti-inflammatory and antiseptic properties. Not only do they contain very little calories, they are an interesting source of fiber and contain phytosterols that could help, if taken in high dose, reduce the cholesterol and triglyceride levels. Very helpful to improve one's cardiovascular health.
Herbs add delicious flavour and comes with an added bonus of being good for you! Image Credit
However, the overall daily intake is relatively small compared to other ingredients. Parsley contains three times more Vitamin C compared to oranges but you'll need three bowls to cover the daily recommendations. Not very easy!

Still, if you consume herbs all day long at different meals, it will cover part of your nutritional needs.
References:
I would recommend to consider them for what they are, aromatic plants. They can make your dishes more tasty and delicious. The healthy part is a bonus.

Cinnamon herb is an excellent diuretic and anti-inflammatory. Mint can help if you have nausea and it helps digesting, just like coriander.

Conclusion: Vietnamese recipes are healthy, but be careful with the ingredients

There is a Vietnamese paradox: even though Vietnamese food is naturally healthy, full of flavors and nutrients, the trend is towards artificially flavored, industrially processed and nutrient enriched food. Pay attention to where you eat and the ingredients used in the preparation of the dishes. A pho might be healthy somewhere because natural ingredients are used, while another one won't be as nutritionous because it uses food enhancers.

Credit: Antoine Yvon - Dietetician/Nutritionist at the CMI Ho Chi Minh City. You can contact him for an appointment (in French). His website: www.nutrytion.fr.

Food database CIQUAL 2013

SMILING 2013

Food composition table for Vietnam, National Institute of Nutrition, Vietnam. 2013

World Health Organization. http://www.who.int/publications/fr. 2014

Food and Agriculture Organization (FAO) 2014

L'histoire de l'alimentation. Jean-Louis FLANDRIN, Edition Fayard. 1996

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Health - Vietnam: Aug. 27, 2018 Vietnamese food is delicious and it is often cited as one of the healthiest cuisines in the world. To make sure that this was true, we spoke to Antoine Yvon, the head nutritionist at CMI hospital in Ho Chi Minh City.

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Balance Diet is very important

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A balanced diet is one that gives your body the nutrients it needs to function correctly. To get the proper nutrition from your diet, you should consume the majority of your daily calories in:

The number of calories in a food is a measurement of the amount of energy stored in that food. Your body uses calories from food for walking, thinking, breathing, and other important functions.

The average person needs to eat about 2,000 calories every day to maintain their weight. However, a person's specific daily calorie intake can vary depending on their age, gender, and physical activity level. Men generally need more calories than women, and people who exercise need more calories than people who don't.

The following examples of daily calorie intake are based on guidelines:

children ages 2 to 8 years: 1,000 to 1,400 calories

girls ages 9 to 13 years: 1,400 to 1,600 calories

boys ages 9 to 13 years: 1,600 to 2,000 calories

active women ages 14 to 30 years: 2,400 calories

sedentary women ages 14 to 30 years: 1,800 to 2,000 calories

active men ages 14 to 30 years: 2,800 to 3,200 calories

sedentary men ages 14 to 30 years: 2,000 to 2,600 calories

active men and women over 30 years: 2,000 to 3,000 calories

sedentary men and women over 30 years: 1,600 to 2,400 calories

The source of your daily calories is just as important as the number of calories you consume. You should limit your consumption of empty calories, meaning those that provide little or no nutritional value. The USDA defines empty calories as calories that come from sugars and solid fats, such as butter and shortening.

According to the USDA, Americans consume empty calories most often in:

At the core of a balanced diet are foods that are low in unnecessary fats and sugars and high in vitamins, minerals, and other nutrients. The following food groups are essential parts of a balanced diet.

Fruits

Besides being a great source of nutrition, fruits make tasty snacks. Choose fruits that are in season in your area. They're fresher and provide the most nutrients.

Fruits are high in sugar. This sugar is natural, though, so fruit can still be a better choice for you than other foods with added sugar. If you're watching your sugar intake or have a condition such as diabetes, you may want to opt for low-sugar fruits. Read on to learn about the 11 best low-sugar fruits, from citrus to peaches. People who are watching their carbohydrate intake may reach for fruits such as melons and avocadoes.

Vegetables

Vegetables are primary sources of essential vitamins and minerals. Dark, leafy greens generally contain the most nutrition and can be eaten at every meal. Eating a variety of vegetables will help you obtain the bountiful nutrients that all vegetables provide.

Examples of dark leafy greens include:

Grains

According to the USDA, Americans consume refined white flour more than any other grain. Refined white flour has poor nutritional value because the hull of the grain, or outer shell, is removed during the refining process. The hull is where the majority of the grain's nutrition lies.

Whole grains, however, are prepared using the entire grain, including the hull. They provide much more nutrition. Try switching from white breads and pastas to whole-grain products.

Proteins

Meats and beans are primary sources of protein, a nutrient that is essential for proper muscle and brain development. Lean, low-fat meats such as chicken, fish, and certain cuts of pork and beef are the best options. Removing the skin and trimming off any visible fat are easy ways to reduce the amount of fat and cholesterol in meats. The health and diet of the animal are important and influence the fatty acid profile of the meat, so grass-fed choices are ideal.

Nuts and beans are good sources of protein and contain many other health benefits, as well as fiber and other nutrients. Try to eat:

Tofu, tempeh, and other soy-based products are excellent sources of protein and are healthy alternatives to meat.

Shop for tofu and tempeh.

Dairy

Dairy products provide calcium, vitamin D, and other essential nutrients. However, they're also major sources of fat, so it may be best to choose small portions of full-fat cheeses, and reduced-fat or fat-free milk and yogurt. Plant-based milks, such as those made from flaxseed, almonds, or soy are typically fortified with calcium and other nutrients, making them excellent alternatives to dairy from cows.

Shop for almond and soy milk.

Oils

Oils should be used sparingly. Opt for low-fat and low-sugar versions of products that contain oil, such as salad dressing and mayonnaise. Good oils, such as olive oil, can replace fattier vegetable oil in your diet. Avoid deep-fried foods because they contain many empty calories.
Shop for olive oil.
The USDA has an online checklist that can help you determine how much of each food group you should consume daily.

Besides adding certain foods to your diet, you should also reduce your consumption of certain substances to maintain a balanced diet and healthy weight. These include:

If you have questions about your diet or feel that you need to lose weight or change your eating habits, schedule an appointment with your doctor or a dietitian. They can suggest dietary changes that will help you get the nutrition you need while promoting your overall health.

Q:

A:

Helpful tips for meals include:

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Balanced Diet: What Is It and How to Achieve It

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You may often hear your doctor or nutritionist tell you the importance of a balanced diet. But what is a balanced diet exactly? Basically, a balanced diet is one that gives your body all the nutrients it needs to function correctly. We explain how to do it, why it's important, and why your daily calorie intake matters.

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The Diet Problem

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Summary: The goal of the diet problem is to select a set of foods that will satisfy a set of daily nutritional requirement at minimum cost. The problem is formulated as a linear program where the objective is to minimize cost and the constraints are to satisfy the specified nutritional requirements.

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The way to help someone diet and lose weight everyday.

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I don't like to put a label on my dietary advice. It is based on scientific research, not ethics, religion or a preconceived notion of what a healthy diet should be like.

But if you want to label it, call it a "Low-Carb, Real-Food" based diet (LCRF).

Let me start by explaining a bit of terminology.

A low-carbohydrate diet minimizes sugars and starches, replacing them with foods rich in protein and healthy fats.

"Real food" means choosing foods that humans had access to throughout evolution. Processed, unnatural foods with artificial chemicals are avoided.

LCRF is not a "diet." It is a way of eating, a lifestyle change based on bulletproof scientific evidence.

It is a way of eating that emphasizes the foods humans have evolved to eat for hundreds of thousands of years, before the agricultural and industrial revolutions.

This type of diet is proven to work better than the low-fat diet still recommended all around the world.

You should limit the following foods.

Sugar: Added sugar is addictive, fattening and a leading cause of diseases like obesity, diabetes and cardiovascular disease (1, 2, 3, 4, 5, 6).

Grains: Avoid grains if you need to lose weight, including bread and pasta. Gluten grains (wheat, spelt, barley and rye) are the worst (7, 8, 9, 10, 11). Healthier grains like rice and oats are fine if you don't need to lose weight.

"Diet" and "low-fat" products: Most of these "health foods" aren't healthy at all. They tend to be highly processed and loaded with sugar or artificial sweeteners. Agave syrup is just as bad as sugar.

Highly processed foods: Foods that are highly processed are usually low in nutrients and high in unhealthy and unnatural chemicals.

You must read ingredient lists. You'll be surprised at the amount of "health foods" that can contain sugar, wheat and other harmful ingredients.

You should eat natural, unprocessed foods that humans are genetically adapted to eating. Research shows that such foods are great for health ( 21, 22, 23, 24).

For healthy people who exercise and don't need to lose weight, there is absolutely no proven reason to avoid tubers like potatoes and sweet potatoes, or healthier non-gluten grains like oats and rice.

If you are overweight or have metabolic issues (low HDL, high LDL cholesterol, triglycerides, belly fat, etc.) you should restrict all high-carb foods ( 25, 26).

Meat: Beef, lamb, pork, chicken, etc. Humans have eaten meat for hundreds of thousands of years. Unprocessed meat is good for you, especially if the animals ate natural foods (like beef from grass-fed cows).

Fish: Fish is great. Very healthy, fulfilling and rich in omega-3 fatty acids and other nutrients. You should eat fish (preferably fatty fish like salmon) every week.

Eggs: Eggs are among the most nutritious foods on the planet. The yolk is the most nutritious and healthiest part. Omega-3 eggs are best.

Vegetables: Contain fiber and many nutrients that are essential for the human body. Eat vegetables every day.

Fruit: Increase variety, taste good, are easy to prepare and rich in fiber and vitamin C. They're still pretty high in sugar, so eat in moderation if you need to lose weight.

Nuts and seeds: Almonds, walnuts, sunflower seeds, etc. Rich in various nutrients, but very high in calories. Eat in moderation if you need to lose weight.

Potatoes: Root vegetables like potatoes and sweet potatoes are healthy, but they're still high in carbs. Eat in moderation if you need to lose weight.

Fats and oils: Olive oil, butter, lard, etc. Choose saturated fats for high-heat cooking like pan frying, they are more stable in the heat.

Coffee: Coffee is healthy and very rich in antioxidants, but people who are sensitive to caffeine should avoid it. Avoid coffee late in the day because it can ruin your sleep.

Tea: Tea is healthy, rich in antioxidants and has a lot less caffeine than coffee.

Water: You should drink water throughout the day and especially around workouts. No reason to drink a whole ton though, thirst is a pretty reliable indicator of your need.

Carbonated soda without artificial sweeteners is fine.

Avoid sodas with sugar and artificial sweeteners, fruit juice, milk and beer.

Simple rule: Don't drink calories.

These indulgences can be enjoyed from time to time.

Dark Chocolate: Choose organic chocolate with 70% cocoa or more. Dark chocolate is rich in healthy fats and antioxidants.

Alcohol: Choose dry wines and drinks that don't contain added sugar or carbs: vodka, whiskey, etc.

This varies between individuals.

Many people feel best eating very little carbs (under 50 grams) while others eat as much as 150 grams, which is still low-carb.

You can use these numbers as a guideline:

When you lower carbohydrates below 50 grams per day, you can't eat any sugar, bread, pasta, grains, potatoes and a maximum of one fruit per day.

I recommend creating a free account on Fitday to log your food intake for a few days. This is great way to get a feel for the amount of carbs you are eating.

Warning For Diabetics: Carbs in the diet are broken down into glucose in the digestive tract, then they enter the body as blood sugar. If you eat less carbs, you will need less insulin and glucose-lowering drugs.

It is very dangerous if your blood sugar drops below a certain level (hypoglycemia). If you have diabetes, consult with your doctor before reducing carbohydrate intake.

Humans evolved as hunter-gatherers for hundreds of thousands of years.

Our diet changed drastically in the agricultural revolution, about 10,000 years ago.

However, this change is small compared to the massive transformation we've seen in the last few decades with modern food processing.

It is quite clear that humans today are eating a diet that is very different from the diet our ancestors thrived on throughout evolution.

There are several "primitive" populations around the world that still live as hunter-gatherers, eating natural foods. These people are lean, in excellent health and most of the diseases that are killing western populations by the millions are rare or nonexistent ( 30, 31).

Studies show that when people eat natural foods that were available to our hunter-gatherer ancestors (also known as the paleolithic diet), they lose weight and see massive improvements in health ( 21, 22, 23, 24).

The Hormone Insulin

The hormone insulin is well known for its role of moving glucose from the blood and into cells. A deficiency in insulin, or resistance to its effects, causes diabetes.

But insulin also has other roles in the body. Insulin tells fat cells to produce fat and to stop breaking down the fat that they carry. When insulin levels are high, the body chooses not to dip in to the fat stores to provide energy.

On a Western, high-carb diet, insulin levels are high all the time, keeping the fat safely locked away in the fat cells.

Carbs are the main driver of insulin secretion. A low carb diet lowers and balances blood sugar and therefore lowers insulin levels ( 32, 33, 34).

When insulin goes down, the body can easily access the calories stored in the fat cells, but it can take a few days to adapt to burning fat instead of carbs ( 35, 36).

Low carbohydrate diets are very satiating. Appetite goes down and people start to automatically eat fewer calories than they burn, which causes weight loss ( 37).

The main advantage of a low-carb diet is that you can eat until fullness and lose weight without counting calories. Eat low-carb and you avoid the worst side effect of calorie restricted diets: hunger.

It is a common misunderstanding, even among health professionals, that low-carb diets are somehow bad for health. People who make such claims obviously haven't bothered to check out the research.

Their main argument is that low-carb diets are bad because they're high in saturated fat, which raises cholesterol and causes heart disease.

But recent research suggests that there is nothing to worry about. Saturated fats raise HDL (the good) cholesterol and change the "bad" cholesterol from small, dense LDL (very bad) to large LDL which is benign ( 38, 39, 40, 41).

The fact is that saturated fat does not cause heart disease. This is simply a myth that has never been proven ( 42, 43, 44).

Low-carb diets actually lead to more weight loss and further improvements in risk factors compared to a low-fat diet ( 45, 46).

1. Blood sugar: One of the hallmarks of diabetes and the metabolic syndrome is an elevated blood sugar, which is very harmful over the long term. Low-carb diets lower blood sugar (50, 51, 52, 53, 54).

2. HDL (the good) cholesterol: Generally speaking, having more of the "good" cholesterol means you have a lower risk of cardiovascular disease. Low-carb diets raise HDL cholesterol much more than low-fat diets (61, 62).

3. sdLDL (the bad) cholesterol: Low-carb diets cause LDL cholesterol to change from small, dense LDL (bad) to large LDL, which is benign (63, 64).

4. Easier: Low-carb diets appear to be easier to stick to than low-fat diets, probably because it isn't necessary to count calories and be hungry, which is arguably the worst side effect of dieting (65, 37).

The statements above have been shown to be true in randomized controlled trials - scientific studies that are the gold standard of research.

When carbs in the diet are replaced with protein and fat, several things need to happen for the body to efficiently use fat as fuel.

There will be major changes in hormones and the body needs to ramp up production of enzymes to start burning primarily fat instead of carbs. This can last for a few days and full adaptation may take weeks.

Common side effects in the first few days include:

Side effects are usually mild and nothing to worry about. Your body has been burning mostly carbs for decades, it takes time to adapt to using fat as the primary fuel source.

This is called the "low carb flu" and should be over within 3-4 days.

On a low-carb diet, it is very important to eat enough fat. Fat is the new source of fuel for your body. If you eat low-carb and low-fat, then you're going to feel bad and abandon the whole thing.

Another important thing to be aware of is that insulin makes the kidneys hold on to sodium. When you eat less carbs, the kidneys release sodium. This is one of the reasons people lose so much bloat and water weight in the first few days.

To counteract this loss of sodium you can add more salt to your food or drink a cup of broth every day. A bouillon cube dissolved in a cup of hot water contains 2 grams of sodium.

Many people say they feel better than ever on a low-carb diet, when the initial adaptation period is over.

If you don't feel good, adding more fat and sodium should take care of it.

This is a sample meal plan for one week that supplies less than 50 grams of carbs per day.
Day 1 - Monday:

Breakfast: Omelet with various vegetables, fried in butter or coconut oil.

Lunch: Grass-fed yogurt with blueberries and a handful of almonds.

Dinner: Cheeseburger (no bun), served with vegetables and salsa sauce.

Day 2 - Tuesday: Day 3 - Wednesday: Day 4 - Thursday: Day 5 - Friday: Day 6 - Saturday: Day 7 - Sunday:

Breakfast: Bacon and Eggs.

Lunch: Smoothie with coconut milk, a bit of heavy cream, chocolate-flavoured protein powder and berries.

Dinner: Grilled chicken wings with some raw spinach on the side.

Do your best to include a variety of vegetables in your diet. If you want to stay below 50g of carbs per day then you can safely have one piece of fruit or some berries every day.

Organic and grass-fed foods are best, but only if you can easily afford them. Just make an effort to always choose the least processed option within your price range.

There is no scientific evidence that you should eat more than 3 meals per day. If you do get hungry between meals, here are a few ideas for snacks that are healthy, easily portable and taste good.

Full-fat yogurt

A piece of fruit

Baby carrots

Hard-boiled eggs

A handful of nuts

Leftovers

Some cheese and meat

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How to Eat Healthy, Lose Weight and Feel Awesome Every Day

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I don't like to put a label on my dietary advice. It is based on scientific research, not ethics, religion or a preconceived notion of what a healthy diet should be like. But if you want to label it, call it a "Low-Carb, Real-Food" based diet (LCRF).

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Our 1,350-calorie-a-day diet features foods that are great at stopping that famished feeling.

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Explain the attitudes, intention and consumption
of a common food (fish) in Vietnam

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Explain the attitudes, intention and consumption
of a common food (fish) in Vietnam

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Vietnam is one of the countries that consume the highest amount of beer in the world.

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Vietnam is one of the countries that consume the highest amount of beer in the world. Since the country people got introduced to this alcoholic beverage in 1900s, beer drinking has become a culture.

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This article said that the high rate was related to the salty diet of many Vietnamese people.

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Update: January, 06/2016 - 08:40

HA NOI (VNS) - Inappropriate dietary and lifestyles have hindered Vietnamese people from preventing and treating contemporary diseases, health experts have warned.

Dr Tran Tuan, director of the Ha Noi-based Research and Training Centre for Community Development, said that Vietnamese people were facing many contemporary diseases, namely cancer and mental and behavioural disorders.

He said that metabolic and endocrine disorders have also been increasing lately.

"Children in modern times become pubescent earlier than before, partly because of diet," Tuan said.

He warned that other diseases such as obesity, high blood cholesterol and eye problems were at high levels in the country.

Meanwhile, deputy head of the National Institute of Nutrition, Nguyen Thi Lam, said that high blood pressure, obesity, cardiovascular problems and diabetes were rapidly increasing in recent years.

"In 1990, there were 8 to 9 per cent of grown-ups in Viet Nam suffering high blood pressure. That was already a high increase in comparison with 1960 with only 1 per cent. But now the figure is up to 30 per cent," she said to Tuoi Tre (Youth) newspaper.

Lam said that the high rate was related to the salty diet of many Vietnamese people.

"A Vietnamese person normally consumes a salt portion which is double to triple that of the recommended 5mg a day," she said, adding that salt intake came from different types of popular food in Viet Nam such as pickles and salted meat.

She also said that Vietnamese people's diet in modern time was unbalanced with less vegetables and fruits.

"On average, a Vietnamese person now eats only 200 grams of vegetable, which is just half of the recommended amount. Meanwhile, the consumption of fruit is just 80 grams a day, which is less than the recommended 100-300 grams," she said.

The diet in modern times was said to lack whole-grain cereals and unsaturated fat.

Lam recommended people maintain a traditional family diet with more vegetables and fruit. People in urban areas are recommended to eat less meat and more beans and peas, drink more traditional herbs instead of fizzy drinks.

The nutritionist also blamed a lack of exercise among Vietnamese people as causing contemporary diseases.

Regarding the refractive errors, Lam said the diseases were caused of eye-using habits, sitting posture and sitting period.

"A recent research shows that Vietnamese children sit a lot. Besides the sitting time at school, many children are spending an additional of three hours sitting for eating, playing and watching TV," she said.

Lam urged Vietnamese people to exercise more, at least 30 to 60 minutes a day for walking, running and other activities. - VNS

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Poor diet, lifestyle fuel health problems

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Update: January, 06/2016 - 08:40 HA NOI (VNS) - Inappropriate dietary and lifestyles have hindered Vietnamese people from preventing and treating contemporary diseases, health experts have warned. Dr Tran Tuan, director of the Ha Noi-based Research and Training Centre for Community Development, said that Vietnamese people were facing many contemporary diseases, namely cancer and mental and behavioural disorders.

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Average fast food consumption per week in 2016 in Vietnam

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Average fast food consumption per week in 2016 in Vietnam

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Vietnam - average fast food consumption per week 2017-2018 | Statistic

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This statistic shows the results of a survey conducted by Cint on the average number of times fast food from quick service restaurants was consumed per week in Vietnam between 2017 and 2018. In 2018, 22.23 percent of respondents in Vietnam stated they eat fast food less than once per week.

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Percentage of high school students who engaged in physical inactivity or unhealthy dietary behaviors

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Percentage of high school students who engaged in physical inactivity or unhealthy dietary behaviors

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Impact of Different Policies on Unhealthy Dietary Behaviors

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Impact of Different Policies on Unhealthy Dietary Behaviors

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They used agent-based modeling to examine the effects of different policies on unhealthy eating behaviors and showed that a 20% increase in taxes on fast foods would lower the probability of fast-food consumption by 3 percentage points.

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Abstract

Objectives. Unhealthy eating is a complex-system problem. We used agent-based modeling to examine the effects of different policies on unhealthy eating behaviors.

Methods. We developed an agent-based simulation model to represent a synthetic population of adults in Pasadena, CA, and how they make dietary decisions. Data from the 2007 Food Attitudes and Behaviors Survey and other empirical studies were used to calibrate the parameters of the model. Simulations were performed to contrast the potential effects of various policies on the evolution of dietary decisions.

Results. Our model showed that a 20% increase in taxes on fast foods would lower the probability of fast-food consumption by 3 percentage points, whereas improving the visibility of positive social norms by 10%, either through community-based or mass-media campaigns, could improve the consumption of fruits and vegetables by 7 percentage points and lower fast-food consumption by 6 percentage points. Zoning policies had no significant impact.

Conclusions. Interventions emphasizing healthy eating norms may be more effective than directly targeting food prices or regulating local food outlets. Agent-based modeling may be a useful tool for testing the population-level effects of various policies within complex systems.

The literature on policy interventions to address obesogenic dietary behaviors can be divided into 3 distinct categories. The first is the use of economic measures to alter food consumption, such as taxing unhealthy ingredients and subsidizing healthy foods, 1-4 in light of studies that have shown the price of a calorie obtained from unhealthful foods is lower than the price of a calorie from more healthful foods. 5,6 The second is targeting the food environment through zoning polices, including increasing the number of healthy food vendors in "food desert" communities 7 and restricting the opening of new fast-food restaurants. 8

The third and final category is related to combating unhealthy eating norms, given research showing the power of food marketing to change dietary behaviors and proposing restrictions on the time, place, and manner in which obesogenic foods are marketed. 9,10 Conversely, pro-nutritional marketing focuses on education as a means of increasing consumers' awareness of dietary health (e.g., nutrition disclosure on menus and the issuing of dietary guidelines). 11,12

The research to date focusing on the effects of these various approaches has incorporated theoretical and empirical techniques that rely on the stable unit treatment value assumption, according to which there are no interactions among people who experience an intervention that would alter the effectiveness of the intervention. However, this assumption is known to be violated in the case of obesity-related behaviors. 13,14 What is therefore not clear from existing regression-based and experimental empirical work is the potential magnitude of the population-level impact of these policies if they were implemented in the real world. We performed simulations to contrast the potential of different approaches aiming at tackling unhealthy dietary behaviors in a population of urban US adults.

Simulations involving systems dynamics or agent-based modeling (ABM) are increasingly being used in public health, 15,16 particularly in addressing food system issues. 17,18 Such techniques can provide virtual laboratories for testing policies 19 and can be useful in studying complex systems, such as dietary behaviors, wherein decisions are influenced by the interplay of socioeconomic, psychological, and physiological forces. 20-22 We used ABM, a powerful technique when there is heterogeneity among members of the population and when behavior changes as a result of interactions between different individuals or between individuals and their environment (i.e., adaptation). 23,24

We developed a computer model explicitly representing how individuals make decisions to examine the impact of policies on their food consumption. Our model was based on a multilevel theory of population health that emphasizes the role of cognitive habits in human behaviors. 25 According to this theory, individual beliefs are influenced by incentives-as in rational-choice theory-but also shaped by cognitive habits that are reinforced within a population by social norms and culture. Thus, our model examined how individual beliefs are influenced by interventions either in the social network or in the food environment.

METHODS

Our agent-based model contained 2 kinds of agents: individuals and food outlets. Individuals make dietary choices, and food outlets adapt to those choices. In our model, a single time period was defined as 1 day, and each simulation was run for more than 3 years (1100 days).

In our simulations, individuals were assigned demographic characteristics (age, gender, educational attainment) matching the demographic distribution of downtown Pasadena, CA. The model accounted for spatial as well as social aspects; individuals were assigned a home location and a set of friends that were both constant throughout the 3-year period.

Outlets were categorized as selling either fresh fruits and vegetables (FV) or fast food (FF). These 2 options represent healthy and unhealthy dietary choices for the purposes of modeling. Each food outlet had a constant location and sold only one type of food in each period. However, food outlets could change the type of food they sold from one quarter (i.e., 90 days) to the next.

Process Overview

Formation of social networks.

Individuals belong to groups of friends, and some also have friendship ties to members of other groups. The presence of densely connected groups and the fact that any individual is only a few social ties away from any other is known as the small-world effect, which is commonly accounted for in the modeling of social networks. 24 Although our baseline scenario relied on small-world networks, we also ran our model under an alternative case with weaker groups, in which social groups were modeled as a random network. (Appendix A, available as a supplement to the online version of this article at http://www.ajph.org, summarizes the models used to generate both network types, together with their calibration.)

Individual decision-making.

Individuals chose to consume FV or FF each period on the basis of taste preferences, health beliefs, a food-price index, price sensitivity, food accessibility, and demographic factors (age, gender, and education). The weight assigned to each factor was based on data derived from the Food Attitudes and Behaviors (FAB) Survey 26 and other empirical studies. The sample for the 2007 version of the FAB Survey (from which our data were taken) comprised 3397 adults; estimates from the 2000 US census were used to provide sampling weights so that the sample was representative of the US population. The survey aimed to evaluate various factors, such as attitudes and beliefs, related to eating behaviors among adults.

During each simulation period, individuals' taste preferences (the stronger their preferences, the more they like the taste of sugary or salty foods) and health beliefs (the stronger their health beliefs, the more they care about the healthiness of food) were updated according to their habits during the preceding period, the influence of their friends, and the food marketing strategies used in the broader environment (the updating function is presented in Appendix B, available as a supplement to the online version of this article at http://www.ajph.org). The models focusing on individuals also evaluated the amount of accessible food within walking distance, defined as 0.25 miles to 1 mile, 27 and food prices.

The models then computed 2 probabilities measured in the FAB data set: the weekly probability of consuming more than 1 meal from an FF restaurant and the daily probability of consuming more than 2 servings of FV. Finally, according to model specifications, individuals consumed FV or FF in proportion to their calculated probabilities. (Equations and parameters are provided in Appendix B.)

Food-outlet adaptation.

In our simulations, food outlets evaluated the food consumption of consumers in the neighborhood and decided whether to sell FV or FF. This evaluation took place quarterly (i.e., once every 90 time points). The model tracked consumption of the type of food sold by each outlet. The probability of switching types of food was proportional to the decline between the current quarter's consumption and that of the preceding quarter (e.g., if average FF consumption decreased by 75%, an FF outlet had a 75% likelihood of switching to sales of FV). In the simulations, outlets did not switch types of food if their sales remained constant or increased.

Model Calibration and Validation

The setting of the simulations was downtown Pasadena, California, an urban district of 1.3 square miles. 28 Pasadena was chosen because its moderate population density, racial diversity, and income levels make it fairly typical of Los Angeles County and similar to the nation as a whole (albeit more diverse). The district was represented by a grid of 260 × 260 cells. In 2010, the district included 113 food outlets that could be categorized as FF venues and 16 outlets that could be categorized as FV venues (e.g., farmers' markets and supermarkets). 29 Each outlet was randomly assigned to one cell, and a sensitivity analysis was performed to assess whether uneven distribution of food outlets would affect model predictions (Appendix C, available as a supplement to the online version of this article at http://www.ajph.org).

Data from the 2010 census showed that the district comprised 17 698 residents aged 18 years or older, 28 and those residents were assigned to unique locations chosen at random. Also, each resident was assigned an age, a gender, and a level of educational attainment. On the basis of these characteristics, residents were then assigned taste preferences, health beliefs, and price sensitivities ().

TABLE 1-

Individual attributes

Female: 51.93%

Education i

Educational attainment

< high school: 10.85%

High school: 16.27%

Some college: 11.64%

College: 61.24%

Taste preference: person prefers sweet and salty foods; age is negatively associated with taste preference

Taste ∈ (0.25-1) if age = 18-54 y

Taste ∈ (0-0.75) if age ≥ 55 y

Health beliefs: person has a strong value for eating healthfully; age, female gender, and educational attainment are positively associated with health beliefs

Health ∈ (0-0.75) if age = 18-54 y and gender = male

Health ∈ (0-0.75) if age ≥ 55 y and gender = male and education < high school

Health ∈ (0-0.75) if age = 18-54 y and gender = female and education < high school

Health ∈ (0.25-1) if all other groups

Price sensitivity: person has a strong preference for cheaper food; age and educational level are negatively associated, and female gender is positively associated, with price sensitivity

PS ∈ (0-0.25) if age ≥ 55 and gender = male and education = college

PS ∈ (0-1) if age = 18-54 y and gender = female and education < high school

PS ∈ (0-0.5) if all other groups

Accessibility of fruit and vegetable outlets and accessibility of fast-food restaurants: person is disinclined to purchase food sold outside of walking distance (0.25-1 mile)

Accessibility = 1 if within walking distance

Accessibility = 0 if outside of walking distance

α

The extent to which an individual is influenced by friends' social norms

α ∈ (0, 0.3), uniform distribution

Environmental attributes

FV price index: weighted FV price index in 2007; set to 0.72 at baseline

FF price index: weighted FF price index in 2007; set to 2.71 at baseline

γ

Visibility weights on social norm of friends: γ ∈ (−1, 1), uniform distribution; set to 0 at baseline

Ratio of stores selling fast food versus fruits and vegetables; set to 7 at baseline

Probability of eating at least 2 servings of FV per day among the residents of downtown Pasadena; Pr(FV) = 0.81

Probability of eating at least 1 meal from a fast-food restaurant per wk among the residents of downtown Pasadena; Pr(FF) = 0.47

To validate our equations, we compared baseline model outcomes (i.e., without interventions) with FF and FV consumption data among the adult population in downtown Pasadena estimated from the 2007 Los Angeles County Health Survey 31 ().

Policy Experiments

On the basis of the calibrated model and assuming constant demographic characteristics, we conducted policy experiments by manipulating the model's 4 environmental attributes. The following policies were tested.

* Tax on unhealthy food: The FF price index in the model was increased 1% up to 20% to reflect the effects of taxes on fat or sugar.

* Subsidies for healthy food: The FV price index was lowered by 1% up to 20% to reflect the effects of increased agricultural subsidies.

* Promotion of healthy norms: Food advertising is associated with a perception that others (peers, friends, and family) like the advertised foods. 32 Therefore, we examined the impact of advertising healthy foods by increasing the visibility (parameter γ in ) assigned to healthy peers from 1% to 10%.

* Regulation of local food environment: We modeled zoning regulations that would alter the makeup of the district with respect to the ratio of stores selling fast food versus fruits and vegetables (FF/FV in ). We lowered the ratio from its baseline value of 7 down to 4 and accounted for the mediating role of accessibility.

These policy experiments and their magnitudes were chosen as realistic policy options. Each run of the simulation took place over 1100 days and included a sample of 5000 participants. For each set of variables, we conducted the simulation 5 times to account for random variation.

RESULTS

Results showed that price-based strategies (i.e., taxing unhealthy food, subsidizing healthy food) could lower FF consumption and increase FV consumption (). However, improvements were small given the tax increases considered (). Promotion of healthy norms exhibited more of an effect: a 10% improvement in the visibility of positive social norms yielded an increase of 7 percentage points in FV consumption and a decrease of 6 percentage points in FF consumption, whereas the impact of a 20% increase in taxes on FF was only 3 percentage points.

TABLE 2-

The results also showed that zoning policies aiming at improving the density of stores selling FV would have no significant impact if individuals' walking distance was set to either 1 mile or 0.5 miles ( and ). Even if individuals were to walk only 0.25 miles (), the likelihood of finding healthy stores would be improved by only 2 percentage points through extensive rezoning (and locating such stores in that small area would be more difficult). However, one interesting result illustrated in is that expanding the buffer from 0.25 miles to 1 mile greatly increases FV consumption, which may indicate that improving transportation is a more effective strategy than rezoning.

Furthermore, promotion of healthy norms continued to have strong effects in both small-world networks and random networks (). The impact on FV consumption remained largely unchanged for each decrease of 10% in the importance of peers' influence (), and a similar effect was witnessed with respect to the impact on FF consumption ().

DISCUSSION

A typical unhealthy diet in the United States is composed of too much high-calorie food and an insufficient amount of fruits and vegetables. Our agent-based simulation model suggests that social networks have significant potential to influence dietary decisions. Although this general point about social networks has been made before, 13 the value of our simulation is to put this insight into a comparative perspective: not only do social networks affect dietary behavior, but they may be the most significant modifiable contributor to such behavior, far stronger than other proposed interventions (e.g., strategies designed to affect the relative prices and availabilities of healthy and unhealthy foods).

Targeting food prices by introducing a tax on fat or sugar or by subsidizing healthy foods may not change dietary behaviors to a great extent. Attracting more FV stores may not exert a powerful influence on behaviors in moderately dense urban areas such as downtown Pasadena, given that people have easy access to both healthy and unhealthy foods nearby. However, improving transportation networks may be an alternative to enhance the accessibility of healthy food in instances in which routes are less walkable.

The policies tested in this study are comparable, and all have been proposed as politically feasible interventions to curb the obesity epidemic. 2,33 Moreover, the magnitudes of the effects derived from our model simulations are similar to what might be expected from other results in the literature. For instance, a few states have imposed small taxes on carbonated beverages, and their experience has suggested that there is no evidence that a tax on these products would have a positive impact on obesity rates. 33 However, one study predicted a slightly larger impact of taxes on food consumption than predicted here. 2 There has been increasing adoption of social marketing in public health, and these efforts have achieved important successes. 34

The use of ABM to understand this public health problem has certain important strengths. First, it provides a measure of the population-level impact of various policies. Although previous research has carefully tested the significance of effects of various determinants of dietary behavior, the next step is to combine these insights into a single, population-based model. ABM may be a fruitful way forward in assessing the overall determinants of population-health outcomes.

Second, unlike statistical models, ABM allows individuals to be connected and influenced by each other, which has considerable effects, as shown in this and other studies. 13,24 The assumption of a stable unit-value treatment effect, on which nearly all statistical analyses depend, makes the statistical testing of social norms difficult 35; however, this difficulty should not be taken to imply that social norms are not important in determining behavior.

Moreover, ABM allows interactions between individuals and the external food environment, which itself can adapt to individuals' consumption. By relaxing this assumption, it is possible to observe the dynamic evolution of obesogenic eating behaviors beyond simply explaining correlations between variables, as statistical models typically do. Unlike most other agent-based models that have studied food systems, 24,36 our model is based on existing theories and an empirical database. A baseline validation was conducted to increase the model's reliability.

Notwithstanding these advantages, our model also has important limitations. First, data are lacking regarding the extent to which people are influenced by their friends. We used a conservative value 13 for this variable. Even a small change in the value led to substantial changes in outcomes, suggesting the necessity of carefully parameterizing this factor in food-choice models. Second, there is little empirical information regarding how much adults' perceptions of social norms can be biased by food advertising, particularly healthy food advertising. The mechanisms relating to how advertising information is disseminated and how it modifies perceptions remain unclear. Third, throughout the simulation, we assumed that population characteristics (age, gender, and education) remained constant at 2010 values and that agents did not change locations. These assumptions may not hold in the presence of in-migration or out-migration, some of which might be endogenous as the food environment evolves.

In summary, our model simulation suggests that norm-based interventions may be more effective in changing unhealthy eating behaviors than tax-based policies or zoning policies. It is beneficial to reinforce and reproduce healthy norms even if individuals do not form communities, suggesting that this strategy does not need to be community based but can also be implemented, for example, via mass media. ABM is useful in developing and testing potential interventions targeting complex health problems.

Acknowledgments

We thank the staff at the Health Behaviors Research Branch, National Cancer Institute, who shared the Food Attitudes and Behaviors Survey data set. Also, we are grateful to participants in the National Institutes of Health Institute on Systems Science and Health workshop and the Johns Hopkins systems workshop hosted by the Global Center on Childhood Obesity for facilitating multidisciplinary teamwork. Finally, we acknowledge the faculty at the Department of Health Policy and Management and the Center for Health Advancement at the University of California, Los Angeles, for their insights and comments on this study.

Human Participant Protection

No protocol approval was necessary because no human participants were involved.

References

19. Gilbert N, Troitzsch KG. Simulation for the Social Scientist New York, NY: McGraw-Hill International; Book Co2005

24. Giabbanelli PJ, Alimadad A, Dabbaghian V, Finegood DT. Modeling the influence of social networks and environment on energy balance and obesity. J Comp Sci. 2012;3(1-2):17-27.

29. California Department of Public Health. Network for a Healthy California. Available at: http://cnngis.org. Accessed March 29, 2014.

35. Manski CF. Identification of endogenous social effects: the reflection problem. Rev Econ Stud. 1993;60(3):531-542.

# data[].attributes.attachment_link.title
Impact of Different Policies on Unhealthy Dietary Behaviors in an Urban Adult Population: An Agent-Based Simulation Model

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Objectives. Unhealthy eating is a complex-system problem. We used agent-based modeling to examine the effects of different policies on unhealthy eating behaviors. Methods. We developed an agent-based simulation model to represent a synthetic population of adults in Pasadena, CA, and how they make dietary decisions.

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This article gives some advice to have a balanced and healthy diet.

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Developing healthy eating habits isn't as confusing or as restrictive as many people imagine. The essential steps are to eat mostly foods derived from plants and limit highly processed foods.