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The risks of poor nutrition.

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SA Health: Your official portal to public health services, hospitals, health information and health careers in South Australia

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How does diet affect a person's health?
If your diet consists of only fresh foods you will have a lower incidence of major chronic disease.

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Taking Charge of Your Health & Wellbeing

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How Does Diet Impact Health? | Taking Charge of Your Health & Wellbeing

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A healthy diet gives your body the nutrients it needs to perform physically, maintain wellness, and fight disease.

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Blowtorches, tweezers and glue: These are just a few of the items used to create those mouth-watering restaurant ads.

To make food look as appealing as possible, food stylists and photographers use a range of instruments, good lighting, fresh ingredients and attention to detail. These tricks of the trade help explain why restaurant meals from the drive-thru often look very different than they do in promotional images.

Using the same ingredients that chain locations use, the fast-food giant's photography and styling team assembled a burger that looks markedly different with the help of a computer program and compared it to one from a McDonald's location.

"Here you can definitely see that there's a size difference," said Hope Bagozzi, McDonald's Canada's director of marketing. "The box that our sandwiches come in keep the sandwiches warm, which creates a bit of a steam effect, and it does make the bun contract a little bit. And then the main difference is that we actually took all the ingredients that are normally hidden under the bun, and we pulled them to the foreground so that you can see them."

Despite the differences, the food is in fact real, stressed the stylists CNBC interviewed.

"It's really important to tell everyone that it's real food," Kalesis said. "There's a lot of misconceptions that people are using fake food, and it's just not true."

"You think models wake up looking like that every day? They have a lot of people making sure they look as good as they can-same thing with food," she said.

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Blowtorches, tweezers and glue: These are just a few of the items used to create those mouth-watering restaurant ads. To make food look as appealing as possible, food stylists and photographers use a range of instruments, good lighting, fresh ingredients and attention to detail.

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How does diet affect a persons health

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How Does Healthy Eating Prevent Disease? | Life Line Screening

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In this blog post, Life Line Screening answers this question: how does healthy eating prevent disease? See the explanation and step towards health today.

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This article talks about what eating habits influence a person's health the most.

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Given the priority for population dietary change there is a need for a greater understanding of the determinants that affect food choice. This review examines the major influences on food choice with a focus on those that are amenable to change and discusses some successful interventions.

1. Major determinants of food choice

The key driver for eating is of course hunger but what we choose to eat is not determined solely by physiological or nutritional needs. Some of the other factors that influence food choice include:

Biological determinants such as hunger, appetite, and taste

Economic determinants such as cost, income, availability

Physical determinants such as access, education, skills (e.g. cooking) and time

Social determinants such as culture, family, peers and meal patterns

Psychological determinants such as mood, stress and guilt

Attitudes, beliefs and knowledge about food

The complexity of food choice is obvious from the list above, which is in itself not exhaustive. Food choice factors also vary according to life stage and the power of one factor will vary from one individual or group of people to the next. Thus, one type of intervention to modify food choice behaviour will not suit all population groups. Rather, interventions need to be geared towards different groups of the population with consideration to the many factors influencing their decisions on food choice.

1.1 Biological determinants of food choice

Hunger and satiety

Our physiological needs provide the basic determinants of food choice. Humans need energy and nutrients in order to survive and will respond to the feelings of hunger and satiety (satisfaction of appetite, state of no hunger between two eating occasions). The central nervous system is involved in controlling the balance between hunger, appetite stimulation and food intake.

The macro-nutrients i.e. carbohydrates, proteins and fats generate satiety signals of varying strength. The balance of evidence suggests that fat has the lowest satiating power, carbohydrates have an intermediate effect and protein has been found to be the most satiating.

The energy density of diets has been shown to exert potent effects on satiety; low energy density diets generate greater satiety than high energy density diets. The high energy density of high-fat and/or high-sugar foods can also lead to 'passive overconsumption', where excess energy is ingested unintentionally and without the consumption of additional bulk.

An important satiety signal may be the volume of food or portion size consumed. Many people are unaware of what constitutes appropriate portion sizes and thus inadvertently consume excess energy.

Palatability

Palatability is proportional to the pleasure someone experiences when eating a particular food. It is dependent on the sensory properties of the food such as taste, smell, texture and appearance. Sweet and high-fat foods have an undeniable sensory appeal. It is not surprising then that food is not solely regarded as a source of nourishment but is often consumed for the pleasure value it imparts.

The influence of palatability on appetite and food intake in humans has been investigated in several studies. There is an increase in food intake as palatability increases, but the effect of palatability on appetite in the period following consumption is unclear. Increasing food variety can also increase food and energy intake and in the short term alter energy balance. However, effects on long-term energy regulation are unknown.

Sensory aspects

'Taste' is consistently reported as a major influence on food behaviour. In reality 'taste' is the sum of all sensory stimulation that is produced by the ingestion of a food. This includes not only taste per se but also smell, appearance and texture of food. These sensory aspects are thought to influence, in particular, spontaneous food choice.

From an early age, taste and familiarity influence behaviour towards food. A liking for sweetness and a dislike for bitterness are considered innate human traits, present from birth. Taste preferences and food aversions develop through experiences and are influenced by our attitudes, beliefs and expectations.

1.2 Economic and physical determinants of food choice

Cost and accessibility

There is no doubt that the cost of food is a primary determinant of food choice. Whether cost is prohibitive depends fundamentally on a person's income and socio-economic status. Low-income groups have a greater tendency to consume unbalanced diets and in particular have low intakes of fruit and vegetables. However, access to more money does not automatically equate to a better quality diet but the range of foods from which one can choose should increase.

Education and Knowledge

1.3 Social determinants of food choice

Influence of social class

What people eat is formed and constrained by circumstances that are essentially social and cultural. Population studies show there are clear differences in social classes with regard to food and nutrient intakes. Poor diets can result in under- (micronutrients deficiency) and over-nutrition (energy over consumption resulting in overweight and obesity); problems that face different sectors of society, requiring different levels of expertise and methods of intervention.

Cultural influences

Cultural influences lead to the difference in the habitual consumption of certain foods and in traditions of preparation, and in certain cases can lead to restrictions such as exclusion of meat and milk from the diet. Cultural influences are however amenable to change: when moving to a new country individuals often adopt particular food habits of the local culture.

Social context

Social influences on food intake refer to the impact that one or more persons have on the eating behaviour of others, either direct (buying food) or indirect (learn from peer's behaviour), either conscious (transfer of beliefs) or subconscious. Even when eating alone, food choice is influenced by social factors because attitudes and habits develop through the interaction with others. However, quantifying the social influences on food intake is difficult because the influences that people have on the eating behaviour of others are not limited to one type and people are not necessarily aware of the social influences that are exerted on their eating behaviour.

Social support can have a beneficial effect on food choices and healthful dietary change. For example, social support has been found to be a strong predictor for fruit and vegetable consumption among adults. Social support may enhance health promotion through fostering a sense of group belonging and helping people to be more competent and self-efficacious.

The family is widely recognised as being significant in food decisions. Research shows the shaping of food choices taking place in the home. Because family and friends can be a source of encouragement in making and sustaining dietary change, adopting dietary strategies which are acceptable to them may benefit the individual whilst also having an effect on the eating habits of others.

Social setting

1.4 Meal patterns

People have many different eating occasions daily, the motivations for which will differ from one occasion to the next. Most studies investigate the factors that influence habitual food choice but it may be useful to investigate what influences food choice at different eating occasions.

The effects of snacking on health have been debated widely. Evidence shows that snacking can have effects on energy and nutrient intakes but not necessarily on body mass index. However, individuals with normal weight or overweight may differ in their coping strategies when snack foods are freely available and also in their compensatory mechanisms at subsequent meals. Moreover, snack composition may be an important aspect in the ability of individuals to adjust intake to meet energy needs.

Helping young adults to choose healthy snack choices poses a challenge to many health professionals. In the home, rather than forbidding unhealthy snacks, a more positive approach may be the introduction of healthy snack options over time. Moreover, healthy food choices outside the home also need to be made more readily available.

1.5 Psychological factors

Stress

Psychological stress is a common feature of modern life and can modify behaviours that affect health, such as physical activity, smoking or food choice.

The influence of stress on food choice is complex not least because of the various types of stress one can experience. The effect of stress on food intake depends on the individual, the stressor and the circumstances. In general, some people eat more and some eat less than normal when experiencing stress.

The proposed mechanisms for stress induced changes in eating and food choice are motivational differences (reduced concern about weight control), physiological (reduced appetite caused by the processes associated with stress) and practical changes in eating opportunities, food availability and meal preparation.

Studies also suggest that if work stress is prolonged or frequent, then adverse dietary changes could result, increasing the possibility of weight gain and consequently cardiovascular risk.

Mood

Hippocrates was the first to suggest the healing power of food, however, it was not until the middle ages that food was considered a tool to modify temperament and mood. Today it is recognised that food influences our mood and that mood has a strong influence over our choice of food.

Interestingly, it appears that the influence of food on mood is related in part to attitudes towards particular foods. The ambivalent relationship with food - wanting to enjoy it but conscious of weight gain is a struggle experienced by many. Dieters, people with high restraint and some women report feeling guilty because of not eating what they think they should. Moreover, attempts to restrict intake of certain foods can increase the desire for these particular foods, leading to what are described as food cravings.

Women more commonly report food cravings than do men. Depressed mood appears to influence the severity of these cravings. Reports of food cravings are also more common in the premenstrual phase, a time when total food intake increases and a parallel change in basal metabolic rate occurs.

Thus, mood and stress can influence food choice behaviour and possibly short and long term responses to dietary intervention.

2. Eating disorders

Eating behaviour, unlike many other biological functions, is often subject to sophisticated cognitive control. One of the most widely practised forms of cognitive control over food intake is dieting.

Many individuals express a desire to lose weight or improve their body shape and thus engage in approaches to achieve their ideal body mass index. However, problems can arise when dieting and/or exercise are taken to extremes. The aetiology of eating disorders is usually a combination of factors including biological, psychological, familial and socio-cultural. The occurrence of eating disorders is often associated with a distorted self-image, low self-esteem, non-specific anxiety, obsession, stress and unhappiness.

Treatment of an eating disorder generally requires weight stabilisation and one-to-one psychotherapy. Prevention is more difficult to define but suggestions include avoidance of child abuse; avoidance of magnifying diet and health issues; showing affection without over-controlling; not setting impossible standards; rewarding small attainments in the present; encouraging independence and sociability.

3. Consumer attitudes, beliefs, knowledge and optimistic bias

Consumer attitudes and beliefs

In both the areas of food safety and nutrition, our understanding of consumers' attitudes are poorly researched. A better understanding of how the public perceive their diets would help in the design and implementation of healthy eating initiatives.

The Pan-European Survey of Consumer Attitudes to Food, Nutrition and Health found that the top five influences on food choice in 15 European member states are 'quality/freshness' (74%), 'price' (43%), 'taste' (38%), 'trying to eat healthy' (32%) and 'what my family wants to eat' (29%). These are average figures obtained by grouping 15 European member states results, which differed significantly from country to country. In the USA the following order of factors affecting food choices has been reported: taste, cost, nutrition, convenience and weight concerns.

In the Pan-European study, females, older subjects, and more educated subjects considered 'health aspects' to be particularly important. Males more frequently selected 'taste' and 'habit' as main determinants of their food choice. 'Price' seemed to be most important in unemployed and retired subjects. Interventions targeted at these groups should consider their perceived determinants of food choice.

Attitudes and beliefs can and do change; our attitude to dietary fat has changed in the last 50 years with a corresponding decrease in the absolute amount of fat eaten and a change in the ratio of saturated to unsaturated fat.

Optimistic bias

There is a low level of perceived need among European populations to alter their eating habits for health reasons, 71% surveyed believing that their diets are already adequately healthy. This high level of satisfaction with current diets has been reported in Australian, American and English subjects.

If people believe that their diets are already healthy it may be unreasonable to expect them to alter their diets, or to consider nutrition/healthy eating as a highly important factor when choosing their food. Although these consumers have a higher probability of having a healthier diet than those who recognise their diet is in need of improvement, they are still far short of the generally accepted public health nutrition goals. It is also unlikely that these groups will be motivated further by dietary recommendations. Hence, future interventions may need to increase awareness among the general population that their own diet is not wholly adequate in terms of, for example fat, or fruit and vegetable consumption. For those who believe their diets to be healthy it has been suggested that if their beliefs about outcomes of dietary change can be altered, their attitudes may become more favourable and they therefore may be more likely to alter their diets. Thus, a perceived need to undertake change is a fundamental requirement for initiating dietary change.

4. Barriers to dietary and lifestyle change

Focus on cost

Household income and the cost of food is an important factor influencing food choice, especially for low-income consumers. The potential for food wastage leads to a reluctance to try 'new' foods for fear the family will reject them. In addition, a lack of knowledge and the loss of cooking skills can also inhibit buying and preparing meals from basic ingredients.

Time constraints

Lack of time is frequently mentioned for not following nutritional advice, particularly by the young and well educated. People living alone or cooking for one seek out convenience foods rather than cooking from basic ingredients. This need has been met with a shift in the fruit and vegetables market from loose to prepacked, prepared and ready-to-cook products. These products are more expensive than loose products but people are willing to pay the extra cost because of the convenience they bring. Developing a greater range of tasty, convenient foods with good nutritional profiles offers a route to improving the diet quality of these groups.

5. Models for changing behaviour

Health Behavioural Models

Understanding how people make decisions about their health can help in planning health promotion strategies. This is where the influence of social psychology and its associated theory-based models play a role. These models help to explain human behaviour and in particular to understand how people make decisions about their health. They have also been used to predict the likelihood that dietary behaviour change will occur. This section focuses on a select few.

The Health Belief Model (HBM) and the Protection Motivation Theory

The Theory of Reasoned Action (TRA) and the Theory of Planned Behaviour (TPB)

1. attitudes,

2. perception of social pressure to perform the behaviour and

3. perceived control over the behaviour.

In dietary studies TPB/TRA enables a comparison of the strength of influences upon individuals and between sample groups and can be used to build an understanding of the determinants of food choice. The TRA has been successful in explaining behaviours such as fat, salt and milk intake. The TPB model was also used to help explain attitudes and beliefs about starchy foods in the UK.

Stage classification for health-related behaviour

The Stages of Change model developed by Prochaska and co-workers suggests that health related behaviour change occurs through five separate stages. These are pre-contemplation, contemplation, preparation, action and maintenance. The model assumes that if different factors influence transitions at different stages, then individuals should respond best to interventions tailored to match their stage of change.

The Stages of Change model, in contrast to the other models discussed, has proven to be more popular for use in changing behaviour rather than in explaining current behaviour. This is probably because the model offers practical intervention guidance that can be taught to practitioners. In addition, large random samples can be tested with messages tailored to the person's stage of readiness to change.

It has been suggested that a stage model may be more appropriate for simpler more discrete behaviours such as eating five servings of fruit and vegetables every day, or drinking low-fat milk (food-based goals) than for complex dietary changes such as low-fat eating (nutrient-based goal).

Presently, no one theory or model sufficiently explains and predicts the full range of food-choice behaviours. Models in general should be viewed as a means to understanding the factors influencing individual decisions and behaviour. Despite the number of models of behaviour change, they have been employed in relatively few nutrition interventions; the Stages of Change model being the most popular. However, the best test of this model, whether stage-matched dietary interventions outperform standardised approaches, has yet to be performed.

6. Changing food behaviour: successful interventions

Dietary change is not easy because it requires alterations in habits that have been built up over a life-time. Various settings such as schools, workplaces, supermarkets, primary care and community based studies have been used in order to identify what works for particular groups of people. Although results from such trials are difficult to extrapolate to other settings or the general public, such targeted interventions have been reasonably successful, illustrating that different approaches are required for different groups of people or different aspects of the diet.

Interventions in supermarket settings are popular given this is where the majority of the people buy most of their food. Screening, shop tours and point-of-purchase interventions are ways in which information can be provided. Such interventions are successful at raising awareness and nutrition knowledge but their effectiveness of any real and long-term behaviour change is unclear at present.

Schools are another obvious intervention setting because they can reach the students, their parents and the school staff. Fruit and vegetable intake in children has been increased through the use of tuck shops, multimedia and the internet and when children get involved in growing, preparing and cooking the food they eat. Moreover, covert changes to dishes to lower fat, sodium and energy content improved the nutritional profile of school dinners without losing student participation in the school lunch programme.

Workplace interventions can also reach large numbers of people and can target those at risk. Increasing availability and appeal of fruit and vegetables proved successful in worksite canteens and price reductions for healthier snacks in vending machines increased sales. Thus, the combination of nutrition education with changes in the workplace are more likely to succeed particularly if interactive activities are employed and if such activities are sustained for long periods.

Tackling several dietary factors simultaneously such as reducing dietary fat and increasing fruit and vegetables, has proved effective in the primary care setting. Behavioural counselling in conjunction with nutrition counselling seems most effective in such settings although the cost implications of training primary care professionals in behaviour counselling are unclear at this time. Educational and behavioural strategies have also been used in public health/ community settings, which have been shown to increase fruit and vegetable intake.

7. Conclusion

There are many influences on food choice which provide a whole set of means to intervene into and improve people's food choices. There are also a number of barriers to dietary and lifestyle change, which vary depending on life stages and the individual or group of people in question.

It is a major challenge both to health professionals and to the public themselves to effect dietary change. Different strategies are required to trigger a change in behaviour in groups with different priorities. Campaigns that incorporate tailored advice that include practical solutions as well as environmental change are likely to succeed in facilitating dietary change.
Reviewed by Dr France Bellisle, INRA, France
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The Factors That Influence Our Food Choices

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This article explains the major factors that influence our food choices with a focus on those we can change and discusses some successful interventions.

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what factors influence a persons diet

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According to the 2012 Demographic and Health Survey (DHS), 18 percent of children in the Kyrgyz Republic under the age of five are stunted, while 43 percent of children ages six to 59 months and 35 percent of women of reproductive age are anemic. The SPRING project in Kyrgyzstan works primarily in Jumgal rayon of Naryn and 10 jurisdictions of Jalabad oblast. This study was conducted to gain a better understanding of dietary practices of families with children under age two and what factors affect family food consumption, child feeding, and nutrition status. The research was conducted over a period of four weeks in October and November in 2014, immediately following the baseline quantitative survey. The methodology was comprised of six different activities; including focus groups with mothers of young children, key informant interviews with men, a participatory activity with women of all ages, focus groups with Village Health Committees, transect walks with a structured observation guide, and health facility assessments.

Findings of this research are intended to inform SPRING project strategies and communication materials. In general, food insecurity did not appear to be a barrier for most households, but dietary diversity is a serious seasonal issue. Fruits and vegetables are seldom consumed in winter due to scarcity and price. Most women believe that infants need additional water and/or food within a month or two after birth because the mother's breast milk is not adequate. The first food is most often a gruel made of browned flour, animal fat, and either water or milk. Women do not seem to know the benefits of immediate breastfeeding for themselves, and maternity center staff lack training on the early initiation of breastfeeding. There is also a lack of awareness among women about the appropriate frequency or amount of complementary feeding. While most women start complementary feeding too soon, SPRING baseline data showed that 12 percent of women delay complementary feeding until eight months, believing breast milk is enough food for their child at this time. The cleanliness of a latrine is not a cultural expectation, and only half of mothers properly dispose of small children's feces. Women in most households have complete mobility and decision-making power to shop for food and seek health services, but mothers-in-law are involved in feeding young children in their households and giving advice to young mothers. Health professionals are perceived as very credible sources of information, providing an opportunity to train them on good counseling skills and build their technical knowledge and capacity.

Key recommendations from the health facility assessment include: collaborating with local government and district health officials to ensure each health facility has the appropriate number of clean, functional latrines or toilets for their staff and patient load; providing all professional health staff training on infant and young child feeding and on anemia, conducting supportive supervision jointly with district health officials; and assisting the Ministry of Health to develop an anemia protocol, including designing a training for health workers on its implementation.

Background

SPRING Project in Kyrgystan

SPRING is a five year USAID-funded Cooperative Agreement to strengthen global and country efforts to scale up high impact nutrition practices and policies and improve maternal and child nutrition outcomes. SPRING provides state-of-the-art technical support and focuses on the prevention of stunting and maternal and child anemia in the first 1,000 days. The project is managed by JSI Research & Training Institute, Inc., with partners Helen Keller International, The Manoff Group, Save the Children, and the International Food Policy Research Institute.

USAID in the Kyrgyz Republic has asked SPRING to improve the nutritional status of women and children within the Feed the Future zone of influence by improving nutrition-related behaviors, enhancing the quality and diversity of diets, and supporting evidence-based nutrition policies. SPRING's geographic focus is Jumgal rayon of Naryn oblast in the north and 10 jurisdictions of Jalalabad oblast in the south. SPRING's work plan includes community interventions and mass media to improve nutrition practices at the household level as well as activities to strengthen delivery of nutrition services, including counseling through the health services.

In October and November of 2014, SPRING undertook formative research in the target areas. The findings, combined with additional information gleaned through a baseline survey, will be used to design an effective behavior change strategy with activities, messages and materials for the target population.

Nutrition Issues Identified in the 2012 Demographic and Health Survey

According to the 2012 Demographic and Health Survey (DHS), 18 percent of Kyrgyz children under the age of five are stunted. The prevalence of stunting varies among regions, with the highest prevalence concentrated in the south in the regions of Osh and Batken. No apparent association exists between stunting and wealth quintile or stunting and mother's educational attainment, and rates of stunting do not differ significantly between urban and rural inhabitants. Just seven percent of women are classified as undernourished, while 31 percent are overweight. Women classified as thin (BMI< 18.5 cm) are more likely to have a stunted child.

According to the DHS, 43 percent of children ages six to 59 months and 35 percent of women of reproductive age have anemia. Anemia prevalence is highest in the regions of Talas and Chui, and lowest in Osh City and Jalalabad regions. As with stunting, there appears to be little association between anemia and wealth quintile or maternal educational attainment, and rates do not differ significantly between urban and rural inhabitants. The DHS reports that only two percent of women took iron supplements for 90 days during pregnancy.

Dietary Intake

Global recommendations suggest that children under the age of six months should be exclusively breastfed, and that children should continue to receive breast milk through the age of two years, with complementary foods introduced at six months of age. Although nearly all mothers in Kyrgyzstan initiate breastfeeding, the DHS indicates that only 38 percent of children are exclusively breastfed at ages 4 to 5 months, the median duration of exclusive breastfeeding is 3.3 months and only 56 percent of children receive breast milk through age two. The findings on infant and young child feeding (IYCF) practices differ somewhat between the DHS and the SPRING baseline conducted in October of 2014 as shown in Table 1 below.

Table 1. Comparison of Infant and Young Child Feeding Indicators, DHS and SPRING Baseline

Dietary diversity for children ages 6 to 23 months with emphasis on food sources rich in iron and vitamin A

Minimum meal frequency for children ages 6 to 23 months

Minimum acceptable diet for children ages 6 to 23 months

Early initiation of breastfeeding

Exclusive breastfeeding from birth through the first six months

Bottle feeding

Timely introduction of appropriate complementary foods

Context of the Target Areas

SPRING works in one district in the northern province of Naryn called Jumgal where the population is of Kyrgyz ethnicity. The entrance to Jumgal is at the edge of a wide plain, but most of Jumgal is mountainous and along a steep and narrow river valley. There is some irrigation along the river for growing grain and potatoes, but most of the agricultural activity in this area focuses on raising livestock, including sheep, goats, horses, and cattle. The baseline survey reports that, on average, families interviewed have 17 sheep, which is their predominant livestock. Much of Jumgal District is at an altitude of 1,850 meters (6,000 feet) or higher, which means barely three frost-free months and a very short growing season. Livestock are moved to high mountain pastures during the summer. There are several mines in Jumgal where some local men are employed. Few men leave Jumgal to work abroad.

Most of the target jurisdictions in Jalalabad Province are equally mountainous, but with a drier climate. These are also pastoral regions, although people have fewer livestock, and some households have a milk cow. Most families grow potatoes, and some families also grow wheat, which they sell and in turn buy flour to make bread. There are forests in the mountains of Jalalabad, including the world's largest native walnut forest. Some of the target districts in this zone are isolated four to five months each winter when roads are blocked by snow.

A geographically smaller but more populous portion of the Jalalabad target area is part of a wide, irrigated, heavily farmed valley. This region has a much greater population density and more ethnic diversity, with as much as one-third of the population non-Kyrgyz - primarily Uzbeks, but also Turks, Kazakhs and Russians. There are some enclaves of conservative Muslims. A greater proportion of people in this area have salaried employment either as professionals, skilled laborers, or on large farms, which are former Soviet collectives. At least one-third of households in this area have someone working abroad as either seasonal or longer-term laborers in Russia, Kazakhstan or the Gulf States. Most rural families and those living in small towns have vegetable gardens and fruit trees. In recent years, there has been rural-to-urban migration to the city of Jalalabad, with families living in substandard conditions in deteriorating apartment blocks. The growing season is almost six months with very hot summers. Throughout this report, the area will be referred to as "Lower Jalalabad" to distinguish it from the mountainous areas.

Purpose of the Formative Research

This formative research was conducted to gain a better understanding of dietary practices for families with children under age two, and what factors affect family diet, child feeding and nutrition status, in order to inform SPRING project strategies and communications materials. The formative research was also used to triangulate findings from the baseline survey. The formative research was designed to answer the following questions:

What do families normally eat in different parts of the target area?

How is that affected by food availability and food access?

Which food groups are particularly affected by seasonal availability?

Does current household food preservation and storage minimize seasonal unavailability?

Are some nutrient-dense foods available and accessible but underutilized?

Is there gender bias in intra-household food distribution?

How much and what food is purchased and what is primarily from home production?

Food Attributes

Are certain foods perceived as unsuitable for pregnant or lactating women, or young children?

Are certain foods considered particularly nutritious?

What do women know about the relative nutritional value of different foods?

What are attitudes towards foods of low nutrient value?

Infant and Young Child Feeding Practices

What are attitudes about colostrum, pre-lacteals and immediate breastfeeding?

What are barriers to exclusive breastfeeding for the first six months of a child's life?

When (and how and with what) is complementary feeding started, and when are other liquids introduced?

Who in the household makes decisions about IYCF practices?

Water Sanitation and Environmental Hygiene

What is the availability and condition of latrines?

What are the barriers to maintaining hygienic latrines?

Are there conditions around houses that expose children to environmental enteropathy?

What is the access to clean water and who carries water to the house?

Health Facilities

How well equipped are health facilities to provide nutrition-related services?

Do health facilities have micronutrient powder (Gulyzak) to distribute? Are iron supplements available in the pharmacy?

Do health staff have practical knowledge about nutrition?

Are there any nutrition education materials available for patients to view or take home?

What are the general conditions of hygiene and sanitation in health facilities?

Methodology

The formative research was conducted over a period of four weeks in October and November of 2014, immediately following the finalization of the baseline quantitative survey which was conducted in late September and early October. A complete schedule of the fieldwork and sites is included in Annex B.

Three members of the SPRING/Kyrgyz Republic staff and one consultant conducted the research, and were assisted in one district by a Peace Corps volunteer. In Jumgal, the two government Health Promotion Unit (HPU) staff were actively involved in leading focus groups and/or taking notes. HPU staff in the two Jalalabad regions assisted in organizing focus groups and interviews, but did not lead focus groups due to a lack of time to train them.

The Health Facility Assessment (HFA) was conducted simultaneously in the same villages by the SPRING Capacity Building Specialist. She always went to the Maternity Center and Family Practice Center for the district and when time allowed, she also visited health facilities in adjacent villages.

Everyone interviewed was read a formal consent statement explaining the purpose of the study and giving them the option to decline to participate. Signed consent forms were collected and have been appropriately filed.

Methods and Tools

Six activities comprised the formative research:

1. Focus groups with mothers of young children;

2. Focus groups or key informant interviews with men from the community;

3. A participatory activity with community women to examine food availability and access;

4. Focus groups with Village Health Committees;

5. Transect walks with a structured observation guide in communities and district centers;

6. HFAs.

The SPRING team and consultant developed guides for each of these activities, adapted primarily from guides used in similar formative research in the region or elsewhere with Feed the Future projects. The guides were translated into Kyrgyz, back-translated and tested before use. English versions of the guides can be found in Annex C. The activities and guides enabled the team to triangulate critical information as well as triangulate findings from the baseline survey. Additional, less-structured opportunistic interviews with individuals filled in gaps in qualitative information.

The HFA tool was adapted from a similar tool used in the USAID Quality Health Care project for prenatal care. The adaptation focused on nutrition-related services of the health system such as anemia, pre-natal nutrition counseling, IYCF counseling, distribution of supplements, and related record-keeping. The HFAs included interviews with health staff, record reviews, and observations.

Team members were given individual training for their assigned activities and worked under the close supervision and guidance of the consultant. After the first day in the field, additional revisions were made to the tools and methods.

Sampling

The first stage of sampling was based on geographic differences. The sample at this stage included Jumgal, lower Jalalabad, and a remote mountain area of Jalalabad, since topography was hypothesized to be a significant factor in food availability and access, together with possible cultural differences in food and child feeding practices between the northern and southern regions of the country. For the second stage, a purposeful sample of nine villages was selected in Jumgal to further capture differences due to topography, physical access, and livelihoods.

Topography was less of a factor in selecting sites in lower Jalalabad than elsewhere, although the purposeful sampling captured one low elevation village and one foothill village as well as urban, peri-urban and rural settlements. One village selected was a former mining town where people do not engage in extensive food production.

Toktogul, the largest mountain district in terms of land area in Jalalabad, was selected to represent the mountain areas because it was still accessible in November from the Bishkek route where the pass is kept open. Villages were purposefully selected in Toktogul to represent both those that are remote and difficult to access, as well as those that are closer to the district center.

Data Management and Analysis

Focus groups and interviews were recorded and transcribed the same day they took place or soon thereafter. Paper copies of notes were typed and shared among the team. Team members debriefed daily and began an initial synthesis of findings. The debriefing helped to further refine the guides and questioning techniques and to identify new threads or additional research questions.

After work in each district or area was completed, team members went through a synthesis process using flip charts to highlight findings. This exercise was completed in English to enable the consultant to begin coding all findings manually. Ultimately, the conclusions coincided completely with those of the initial synthesis.

Key Findings and Implications

Table 2 below highlights key findings and implications from the formative research conducted.

Table 2. Summary of key findings and implications

Findings from SPRING formative research

Implications and recommendations

Factors affecting household food consumption and dietary diversity

Food insecurity does not appear to be a barrier for most households.

Fruits and vegetables are seldom consumed in winter due to scarcity and price.

Fruits that are preserved have high sugar content and few nutrients.

Family gardens do not currently produce a large surplus for preservation.

Unimproved winter storage methods are utilized for potatoes, root crops, cabbage, etc.

There is little or no family knowledge about nutrient content of different foods.

Egg production of rural households is low due to poor poultry care.

There are underutilized foods such as pumpkin.

Families with cash income have more diverse diets.

All families purchase large amounts of sugar, oil, and considerable amounts of sweet snacks.

Mothers eat extra vegetables while preparing food and eat often between meals.

Tea is the beverage of choice at meals, even for very young children.

Focus on increasing availability of, and access to, diverse foods rather than overall food availability.

Improve production of, or access to, more fruits and vegetables to store in winter, and improve storage and preservation techniques. Through AgroHorizons Project, pilot a small business venture to rent out freezer storage.

Seek viable methods or technologies for households to produce vegetables earlier in the spring and later in the fall.

Improve poultry care as well as a sustainable system of vaccination to increase survival.

Disseminate messages and materials on dietary diversity and good food sources for key nutrients.

Promote consumption of available vitamin-rich foods which are currently not consumed at high levels.

Create awareness of the concept of "empty calories" and the health risks of overweight and obesity.

Encourage consumption of herbal teas or water with meals, or milk and local wheat drinks for children and adults.

Further investigate possible food taboos or food-related beliefs for pregnant women.

Breastfeeding

Women do not know the benefits of immediate breastfeeding for themselves.

Maternity center staff lack training on immediate breastfeeding and believe women are too tired to do so after delivery.

Some maternity staff are giving infants formula, sugar-water, glucose water, etc.

Overall, women lack knowledge about exclusive breastfeeding and/or receive false information.

In traditional culture, breastfeeding is considered very important and women receive familial support to breastfeed in terms of time and workload.

A general belief persists that breast milk is not sufficient and that infants need supplemental liquids and food.

There is a widespread belief that infants get thirsty without water.

Some believe that infant formula is superior to breast milk.

Women believe they don't produce enough milk. This may be related to poor attachment of their infants.

Complementary feeding starts very young.

Women rarely leave very young infants for others to feed.

Train health workers on the need for immediate breastfeeding and the dangers of pre-lacteals.

Disseminate accurate information to pregnant women and women of all ages about the benefits of immediate breastfeeding, and the meaning of exclusive breastfeeding.

Train health workers to counsel on exclusive breastfeeding and enable them the assist women with attachment and other breastfeeding challenges.

Change the social norm to favor not just breastfeeding but exclusive breastfeeding for six months, including promoting understanding that infants do not need other foods or liquids during this time.

Complementary feeding

Generally children start receiving food at three months. This is a thin porridge - bulamyk - which is made from browned flour with animal fat, milk or water, and sometimes with sugar.

Some women (12% in the baseline survey) delay complementary feeding until eight months, believing breast milk is enough. Women have not heard recommendations on when to start complementary foods.

Women do not have an understanding of what foods are good for young children in terms of relative nutrition content.

There is a lack of awareness among women about the appropriate frequency of complementary feeding and why such recommendations are made.

Mothers feel frequent feeding would take too much of their time.

There is widespread use of sweet biscuits as a weaning food and children are also given cake, pastries, and candy at very early ages.

Link complementary feeding messages to the concept of exclusive breastfeeding so mothers and family members understand the rationale for waiting to introduce complementary foods.

Rather than discouraging bulamyk, focus on improving consistency and nutrient value through the addition of carrots, pumpkin, egg yolk, ground meat or legumes, etc.

Disseminate messages on timing for the introduction of complementary foods, feeding frequency, selection of nutrient-dense foods.

Emphasize convenient, healthy snacks.

Water, sanitation, and hygiene

Most families in Jumgal and Jalalabad have access to piped water.

Some families in Jalalabad are drinking water from unprotected sources, but usually boiling it.

Overall latrine coverage is very high, but most in Jumgal and some in Jalalabad do not have cement slabs.

In general, latrines are not clean or well maintained. Cleanliness of a latrine is not a cultural expectation and there is no sense of shame or disgust about having a dirty one.

Handwashing stations were not observed near household latrines.

Only half of mothers properly dispose of small children's feces.

Access to water does not appear to be a problem, which means it is likely not a factor in nutritional status or hygiene. SPRING will not have to focus on access on water availability.

Make promotion of proper cleanliness of latrines and proper disposal of children's feces a priority. The approach of promoting a sense of disgust or shame related to feces may be useful.

Engage former community members who now live in urban areas with toilets to promote clean latrines and/or indoor toilets.

Investigate further the potential for sanitation marketing to create a desire for [clean] indoor toilets.

Other key findings

Women in most households have complete mobility and decision-making power to shop for food and seek health services.

Mothers-in-law are involved in feeding young children in their households and giving advice to young mothers.

Health professionals are perceived as very credible sources of information but need counseling skills and improved technical knowledge and capacity.

Engage mothers-in-law and all older women, including retired health professionals in the community, as an important secondary audience.

Provide health professionals with accurate information and good counseling skills in order to advise women well.

Detailed Findings

Dietary Pattern by Region

Main dishes and hot foods served are almost always mixed foods, such as hearty soups or rice pilaf, or a pastry filled with meat and or vegetables. Soups are generally served in separate bowls, but in the South, variants of pilaf are sometimes served on a single platter from which the whole family eats. Meals are always accompanied by bread and sometimes by vegetable side dishes known as salat (salad), even if the vegetables are cooked. In summer, fresh raw vegetables and fresh fruit are often served at meals and eaten as snacks. The most commonly served fresh produce are tomatoes and cucumbers. Dill, fresh or dried, is used liberally to season food. There is a strong preference for white bread, but if families grind their own wheat, the bread may be whole wheat. Wheat, buckwheat, and other grains are often served as porridge either in the morning or evening.

There are distinct differences in common foods between Jumgal and the whole Jalalabad area, and lesser distinctions between the mountains and the valley of Jalalabad. In Jumgal, due to the predominance of livestock production and the shorter growing season, animal products figure prominently in the daily diet. Rice is much more common in the Jalalabad area and consumption of fruits and vegetables is higher, at least during the autumn season when the baseline survey and formative research were conducted. Table 3 lists the most commonly consumed foods as described by women participating in the formative research, who reached consensus on these food items.

Table 3. Commonly consumed foods in each area

Milk and milk products - all kinds

Milk products (kefir, yogurt, cream, sary may*)

Milk products (kefir, yogurt, cream, sary may*)

Meat - chicken, goat, mutton or beef (not daily)

Corn in season
Potatoes

Meat - mutton or goat (not daily)

These results were largely verified by the analysis of dietary diversity for women from the baseline survey (see graph in Annex D), however, the formative research also asked about quantity and frequency of consumption. While the baseline indicates a relatively high level of meat consumption in all areas, formative research participants said that they only consume meat three to four days a week and that the amount put in the usual soup, pilaf, or other mixed dish and shared among all family members is small, about 200 grams. With an average size family of five members, this would be only 40g or less than 1.5 ounce each.

Tea, either black or green, is the universal beverage of choice and is taken with meals and in between meals. Tea is generally sweetened and is given to children. The baseline survey found that a quarter of infants ages 0-5 months were given tea and that increased to almost three-fourths of children between ages 6 and 11 months. This is a concern given the role of tea in inhibiting iron absorption from non-heme sources. Women in the focus group discussions (FGDs) also mentioned that families drink milk and a local beverage made from wheat or corn. Fruit juice with sugar, either homemade or purchased, is generally reserved for special occasions.

Factors Affecting Dietary Diveristy

Food Availability

A wide range of foods is available in all regions. Annex E shows which foods are produced, purchased, consumed on a daily basis, and stored. Most nutrient needs could be met through consumption of locally available foods most of the year, with the exception of vitamin C. Local vitamin C food sources are mostly non-existent in winter months, after all stored cabbage is consumed. People in urban areas have access to shops or supermarkets which import vitamin C-rich foods, however, FGD participants indicated these foods are too expensive for regular consumption. Imported lemons make their way to most market towns, but are used sparingly in tea. The lack of vitamin C is related to the issue of anemia since the vitamin enhances the absorption of any non-heme iron that is consumed.

Red meat is available and is consumed, at most, two or three times a week. Furthermore, the amount consumed by any one family member is small. Families who have chickens report eating more eggs and eating them more often than those who do not have chickens. Egg production from chickens is generally limited, however, since hens are often not kept enclosed or fed well. Households with chickens report frequent epidemics of Newcastle and other possible diseases since there is no longer a vaccination program and the vials of vaccine, when available, are for 100 chickens, which is not practical for smaller household use. The baseline survey reports that the average number of chickens among households who have chickens is six for Jumgal and five for Jalalabad.

There are locally available nutrient-dense foods that are currently underutilized. One of particular note is pumpkin, which grows well in Jumgal. People there report that they don't know how to use it and often just feed it to their chickens. These pumpkins ( cucurbita moschata) keep well long into the winter and are an excellent source of vitamin A. They also grow well in Jalalabad, and people there have various ways of cooking them. Pumpkin leaves as well as from leaves from radishes, beets, and turnips are not consumed at all, but would be a good source of iron and offer some vitamin A as well.

Food Access

Families with cash income eat a much more varied diet than families that produce most of their own food. This was true even in the remote mining communities where food has to be brought in from market towns or purchased in shops. These families reported not only eating more processed food, but also a larger variety of meats and vegetables in particular. In contrast, families with land and livestock but less cash income seem to confine their food choices to what they can produce, purchasing very little except oil, sugar, salt and some foods of low nutrient value such as cakes and instant noodles. In both cases, there does not seem to be much purchasing or trading conducted within communities among neighbors.

The common sentiment about fruit and vegetable purchases is that they are always less expensive in a market town than in more rural areas, and those who live in market towns perceive that produce is cheaper in the next bigger market town, so they sometimes pay for transport to go shopping there. Some women did report that the cost of transport to reach the nearest market or the time involved travelling is a barrier to purchasing fruits and vegetables. On the other hand, professional working women interviewed as key informants in Jumgal mentioned the lack of time is a barrier to purchasing food, particularly to seeking out diverse foods in their local market and shops.

The World Food Programme Food Security Assessment conducted in September of 2013 found that approximately 14 percent of households, primarily day laborers and pensioners, were food insecure. Focus group participants confirmed that these are the groups spending the largest share of their income on food. They mentioned that there is a protective factor in rural households where young couples with small children sometimes live with parents, thus reducing their need to completely depend on their own income for sustenance.

Food Preservation and Storage

Most families contacted in the formative research, with the exception of some urban families, say they store and preserve foods for winter. The foods preserved or stored are fruits or vegetables, including tubers. The formative research did not investigate grain storage since under-consumption of cereal foods is not an issue. In urban households, the main limitation is space, although even some urban households keep tubers, apples, and cabbages in a cold room. They further pointed out that they can buy fresh fruits and vegetables in the market and shops year around, although at high prices in winter.

Foods that are stored rather than preserved include potatoes, cabbages, root vegetables such as carrots and turnips, apples, pomegranates, and pumpkins. According to the baseline, the most common place for storing produce is in a cellar under the house. Potatoes, cabbages, and root vegetables are sometimes buried in trenches and will keep that way for three or four months, with potatoes keeping even longer. This system is quite primitive and all can be lost in severe winters. Apples, pomegranates, some root vegetables and cabbages are sometimes stored in an unheated room, where they will keep for up to three months. Grapes, persimmons, tomatoes and eggplants can be stored in a cool place for up to two months. Families reported that they always consume the stored food by late winter and then must purchase additional potatoes, carrots, and other produce or, if prices are too high, they go without.

The baseline survey asked specifically about what foods are stored and about approximate quantities of those foods. Details are provided in Annex F. The amounts stored are significant. In Jalalabad and some communities of Jumgal, families reported purchasing additional vegetables to store, which implies that home garden production is not sufficient to meet their needs.

Day-to-day food storage is facilitated by the fact that nearly all villages have electricity and most families (85 percent in the baseline survey) have a refrigerator. This has made it much easier for families to store perishable foods such as meat and dairy products as well as leftover food. However, the amount of the products that can be stored at one time or for longer than a few days is limited by the small size of the refrigerators and by erratic power outages in winter.

Food preservation is widely practiced. Ninety five percent of women interviewed for the baseline in Jalalabad and 71 percent of those in Jumgal preserved food in 2014. Food preservation involves manipulating fresh products in order to stop ripening and slow or halt decomposition by bacteria, yeast, and molds. This is most often done by sealing off air, or by adding sugar, salt, or acid. This manipulation may also involve heating the product. The most common method of preservation, namely canning, consists of packing foods that have been sterilized by heat into jars and sealing out all air. Ideally, the jars are also sterilized prior to filling them, and the filled jars are further processed in boiling water or with steam pressure to kill anaerobic pathogens such as botulism. These last two steps, which are globally recommended, are not always practiced in Kyrgyzstan.

Produce most commonly preserved in all regions are cucumbers as pickles, and tomatoes. There are a lso varying versions of mixed vegetables, which are usually sautéed in oil before being sealed in jars. These are simply known as "salad" and present the most risk for botulism because they are low in acid. Soft fruits such as berries are made into jam. Other fruits, particularly apples, cherries, plums, and peaches are canned as "compote" which is a small amount of fruit with water and sugar added. In the case of fruits, whether preserved as jam or as compote, the long cooking time destroys virtually all the vitamin C content, which means they primarily contribute calories and some fiber to the winter diet. During field work, it was evident that rural women were very proud of their canning efforts and motivated to preserve food this way as much by an enjoyment of the flavors as by the need for a variety of food available in winter. From observations during the formative research, the amount of food canned or pickled is small for the size of the households.

The other method for preserving food, used primarily in the south, is solar drying. Eighteen percent of families interviewed for the baseline in Jalalabad had dried some food. This method is used for apricots, plums, and grapes. When asked, people had not heard of drying vegetables. It should be noted that the hot dry summers in the south are good for this type of food preservation. Much of the fruit that is dried is sold rather than saved for home consumption.

Other than tiny compartments in refrigerators, people in the target area do not have access to freezers. Freezing fruits and vegetables would preserve more nutrients, eliminate the need to add sugar or salt, remove the risk of anaerobic food borne illness, and be much more cost effective than canning, which requires expensive jars, lids, and heat.

Food Attributes

Women in the focus groups and in the food availability exercise were asked to name foods that are forbidden for, or not consumed by, different family members, including pregnant women and young children. In all regions, but particularly in Jumgal, women had received a message that the frozen chicken sold in markets and shops (usually imported from China) is full of hormones and dangerous to the health of everyone. They said they previously consumed more chicken until they learned this. It is unclear where the message originated, but it seems to have been widely disseminated in very recent years.

In lower Jalalabad, women said they wouldn't use cottonseed oil, preferring oil made from other plants such as corn or soy. This may be because of their intimate knowledge of cotton-growing, including heavy use of pesticides on the crop.

There is also concern about the safety of eating purchased mayonnaise. No one could articulate what the safety issue might be, but a government decree banned it from being served in preschools and kindergartens. This issue has been around for quite some time.

Women have heard that liver is good for preventing and curing anemia, but they shy away from eating it because they have frequently seen liver flukes when butchering an animal. This is an animal health issue that could be addressed by agriculture programs.

The only foods that women identified as unacceptable for very small children were spicy foods made with peppers. They said that children wouldn't like them. More investigation could be completed about foods deemed unacceptable for small children.

The theme of foods considered unacceptable for pregnant and lactating women needs to be further explored as nothing emerged in the discussion. This may have been because of the presence of health workers in the focus groups.

Food Consumption within the Household

Families reported that they eat two or three meals together per day. Some families prepare hot food only for the evening meal. Women are responsible for food preparation. They were asked during focus groups whether they eat while preparing food and all reported that they do, particularly raw vegetables such as carrots, cabbage, tomatoes, cucumbers, and onion. They also share these snacks with children who are present. Women also reported that they often eat while cleaning up after a meal, for example, finishing soup left by a child.

Foods women consume between meals

Jumgal: bread, cookies, apples, wheat national drinks, corn drink, kefir

Jalalabad: bread, cookies, apples, dried or fresh apricots, kefir

Toktogul: bread, cookies, corn when in season, wheat drinks

Women in the focus groups said they frequently eat between meals, often three or four times a day. This practice was much more common among women who do not work away from home. Snacks vary somewhat across the regions as shown in the box at the left. This non-meal food consumption may be a significant source of extra nutrients and calories for women.

When asked whether men are favored in intra-household food distribution, there was consensus that men get a larger serving, but are rarely served different foods than the rest of the family because of the mixed dishes. Women in focus groups commented that if men and boys need more to eat, they can fill up on bread.

Leftover main dishes from the previous day are frequently re-heated to give to men for breakfast. Women and children are more likely to eat porridge, bread and jam for breakfast, always with tea in all regions. Table 4 shows the usual meals eaten in different regions.

Table 4. Foods Most Often Prepared for Family Meals

Breakfast

All regions: milk, cream, tea with bread, tea with jam or sugar, leftovers from the night before (mostly for men), butter or homemade sary may, and sometimes porridge made of buckwheat or wheat

Lunch

Jumgal: fried potatoes, macaroni, eggs

Jalalabad: milk with rice, pumpkin with milk

Toktogul: rice or pasta with vegetables

Dinner

Jumgal: mostly soup but also pasta filled with meat or vegetables (manti, samsa)
(soup is meat broth with carrots, potatoes, herbs, sometimes meat, other vegetables)

Jalalabad: rice soup with vegetables, rice pilaf, with meat at least once a week

Toktogul: rice pilaf with or without meat, pasta filled with meat and vegetables

Focus group participants said that many pregnant women eat more than three meals a day. Some said when they were pregnant, they ate four, five, or even six small meals. They get advice from health workers to eat more during pregnancy and to eat more fruits and vegetables.

Nutrition Knowledge

Women who participated in the formative research exercises understand that some foods are better or more nutritious than others. Very few women, however, know the relative nutrition content of different foods. This lack of knowledge included health workers. For the most part, they were unable to identify good food sources for different nutrients when presented with a range of food photos. They could say that fruits and vegetables "are good for the body", or that "vitamins prevent diseases." They knew that it is important to use iodized salt, and many were able to explain that iodine prevents goiter, but others said it is for "making children grow smarter."

Only the men who are Village Health Committee (VHC) members had some concept of malnutrition and anemia and their consequences. Other men in the focus groups and interviews equated the word nutrition with food in general. Some expressed that animal source foods make people stronger and healthier.

Current Child Feeding Practices

Immediate Breastfeeding

The most revealing information about immediate breastfeeding came from the baseline survey results. Virtually all children are delivered in maternity centers and women stay there with their infants for approximately five days. The survey found that almost all children were put to the breast within a few hours of birth, however, 11 percent of infants in Jalalabad and seven percent in Jumgal were given a pre-lacteal, usually infant formula or sometimes sugary water. It seems probable that the decision to give the pre-lacteal is being made by maternity staff rather than by the mother and is in accordance with the existing protocol for low birth weight infants or for women who have had a caesarian section.

Exclusive Breastfeeding

According to the baseline survey, 99 percent of new mothers initiate breastfeeding, however infants start receiving other liquids at one month and gruel by three or four months of age. Only one-third of children ages 0-5 months in the survey were being given breast milk exclusively, which is much lower than the 56 percent reported in the DHS.

Table 5. Liquids consumed by children ages 0-5 months

In the focus groups, women said they start giving other liquids because they think their young child must be thirsty. Many also said they are afraid they are not producing enough breast milk and some said they think infant formula is good for the child. Some said they have been told by health workers that breastfeeding is still considered exclusive if they are only giving other liquids, but not food, to their child. Table 5 highlights liquids consumed.

No one talked about breast problems interfering with breastfeeding. Women agreed that they don't leave breastfeeding babies with caretakers except in real emergencies and then, they might leave formula or cow milk for the child. Using a bottle to feed the other liquids is common, even among children older than six months.

There is a general belief, particularly in Jumgal, that breast milk is not sufficient after two or three months, that the baby is hungry and therefore that it is necessary to start giving semi-solid food. This is usually a thin gruel described further below in the section on complementary feeding.

About a third of women in the focus groups say they still use a traditional cradle with swaddling. Babies are left in the cradle four to five hours at a time or overnight. It is unclear whether babies are lifted out for breastfeeding, and if not, what effect this might have on breast milk production.

In general, breastfeeding is viewed as an important practice, and women receive support from their mothers-in-law and other family members to have time to breastfeed and to eat well while lactating. However, as shown in the baseline survey, women discontinue breastfeeding long before the recommended two years, with only about half of women still breastfeeding when the child is one year old. During focus groups, women said they quit when they become pregnant again or when they took a medicine, or when they had no more milk. A few women mentioned that the Quran says not to breastfeed when pregnant with another child, but eminent religious leaders say that this is not found in the Quran.

Complementary Feeding

In both target areas, but particularly in Jumgal, complementary feeding starts too early rather than too late. The baseline reported that fewer than 15 percent of children between the ages of 6 and 8 months were not getting food in addition to breast milk. By nine months, all children were being fed solid or semi-solid food.

The most common first food in both regions is a gruel called bulymak, which is made by browning flour in animal fat and adding either milk or water, and sometimes sugar. At first, it is made to be very thin, but as the child grows, the thickness of the gruel increases. Many women in the focus groups reported giving this food to their child daily while others said they made it every other day. Children are also given other porridges, mashed potatoes and rice as early foods. Many women also give sweet biscuits or bread.

Women in the focus groups said they feed their child at regular mealtimes and many give small children snacks as well. It appeared that many had not received messages about how often to feed their child and some who had heard the recommendation thought it meant preparing hot food more times a day, which they wouldn't have time to do. Most women said children are given food on a separate plate.

Table 6 lists the different foods children ate in the 24 hours prior to the baseline survey. Children ages 6-23 months in Jumgal ate a mean of 2.9 food groups out of seven, while in Jalalabad the mean was 3.3 food groups. The table shows that children in Jumgal were given more animal source foods while children in Jalalabad were given more vegetables, which is consistent with the focus group findings.

Table 6. Solid and semi-solid food consumption among children ages 0-5 months yesterday during the day or night

In general, women participating in focus groups did not appear to have received much information about optimal child feeding practices. They reported getting some advice from health workers, but tend to follow suggestions from their mothers or mothers-in-law to feed the child in traditional ways.

Water, Sanitation, Hygiene

Access to Clean Water

Access to clean, piped water in Jumgal is generally very high. Families go only a short distance to a public standpipe to retrieve water and some families have a standpipe in their yard. According to local leaders, approximately 5 percent of families have water piped into their homes. According to the baseline survey, few families in Jumgal treat their water, which may be acceptable since the water is coming from a protected source.

The situation is more complex in Jalalabad, as shown in the graph to the left, where many more people have access to water piped into their yard or dwelling, with approximately one quarter of households getting water from a public standpipe, and the rest getting surface water or water from an unprotected spring. The baseline survey reported 98 percent of families surveyed say they treat their water, usually by boiling. The concern is the 13 percent of families that use surface water, which is often contaminated by agro-chemicals or mining waste in this zone. During the formative research, boys were observed drinking from a drainage channel along a street as well as from an irrigation ditch.

Latrine and Toilet Coverage and Condition

The 2012 DHS reports that 99 percent of all households and 94 percent of rural households have a ventilated improved latrine or a latrine with a slab. This definition of slab did not specify material. The 2014 Multiple Indicator Cluster Survey (MICS) reports that 97.5 percent of all households have access to an improved toilet facility, with no definition given for "improved." The SPRING baseline also considered any latrine with a slab as improved, but the translation of the word "slab" in Kyrgyz specifies that the slab has to be cement/concrete, not wood or other material. With this more specific definition, 90 percent of households in Jumgal and 31 percent in Jalalabad use unimproved latrines. The formative study used observation to verify this and also observed for the presence of latrines at public institutions (schools, health facilities, eating establishments, etc.) and the hygienic conditions of the toilet facilities. Observations are highlighted in Annex G.

Researcher observations revealed that many or most latrines are in poor condition, and roofs and doors are sometimes missing. Some were located quite close to houses, but most were a reasonable distance away. No handwashing facilities were observed close to household latrines. Most importantly, the latrines observed were unclean, with excrement all around the hole. Virtually all latrines observed in Jumgal and many in Jalalabad have a wooden "slab" which is considered an "improved latrine" by international definition, but these are harder to clean than cement and subject to rotting away quickly.

Not all health facilities have latrines. The ones that had latrines kept them only slightly cleaner than household latrines. Toilets inside hospitals and maternity centers were reasonably clean although some lacked running water, hence, were pour-flushed. Water and soap were available for handwashing at health facilities.

The situation at schools is concerning. All of those observed had some kind of latrine and usually had separate sides for boys and girls, but there was often just one of each for a school with many students, and all of them could be described as filthy. In two cases where donors had constructed very nice latrines of sufficient number for both boys and girls, these new facilities were locked up and unused. Only these new latrines had handwashing stations.

If anything, latrines observed in other establishments including a restaurant, city hall, office buildings, and business establishments were the least hygienic of all. It was evident that anyone who enters one will subsequently track fecal matter outside upon leaving, which has serious health implications. While very small children may not go near latrines, the pathogens are brought right to their play areas.

Since the formative research team could not find clean household latrines in order to conduct a Doer/Non-doer study of the barriers and motivators to maintaining clean latrines, the study relied on interviews with school personnel and VHCs, using a tactic of having them analyze the reasons why other people in their communities don't use latrines properly and keep them clean. To assess potential for sanitation marketing, the study team also asked random individuals in Jumgal about interest in, and barriers to, indoor plumbing as well as why the few households who have indoor toilets keep them clean.

It is evident both from observations and discussions that the prevailing social norm is unclean latrines. There is no felt need to keep them clean, no sense of disgust or shame because everyone's latrine is in the same unhygienic state. Other barriers cited by the VHCs include the lack of running water near homes, the lack of cleaning materials, and laziness. On the other hand, there was agreement that the incentive to keep indoor toilets clean is to prevent or eliminate odors. Obviously, anyone who has an indoor toilet also has piped water which makes cleaning easier.

When asked, individuals cited that the principal reason they might want, or have, an indoor toilet is for the benefit of an elderly or disabled household member. No one mentioned other benefits of indoor plumbing such as not having to go out into the cold or for the convenience of small children. For most households in Jumgal, cost is the major barrier to an indoor toilet, because they would not only have to pay for plumbing the house but also for putting piped water into the house from the nearest source and building a septic tank.

The results of the baseline survey reveal a problem with proper disposal of children's feces. More than half of women in both Jumgal and Jalalabad did not dispose of their children's feces properly by putting them in the latrine or toilet. Table 7 below shows that feces are often simply left outside the house or put in the trash. The formative research did not investigate attitudes about children's feces or why they are not put in the toilet or latrine, therefore, this will have to be included in another round of research.

Table 7. Location of child feces disposal last time child passed stools

Other Environmental Hygiene Issues

The study team observed additional aspects of environmental hygiene as well. In smaller villages, garbage disposal was a very evident problem. Household garbage is tossed into vacant lots or left along the side of the street. One of these dump sites of waste from a market area was adjacent to the Jumgal District Hospital complex. Domestic animals scavenge in the garbage while children play nearby.

In observing for conditions that are associated with environmental enteropathy, such as children's contact with animal feces, the team noted that chickens roam freely around dooryards. Other livestock are kept in pens farther from the house, but manure may be tracked on shoes to the house, although shoes are always removed before entering the house. Women appeared quite conscious of what children were putting in their mouths and children are generally set down on rugs, not directly on the ground. Therefore, we concluded that exposure to environmental enteropathy pathogens is not high, except in summer when small children may play outdoors without direct supervision.

Handwashing

According to the baseline survey, most women reported that they wash their hands after going to the toilet, before eating, and before preparing food, but less than half wash their hands before feeding a child and very few wash their hand after toileting a child. This last action provides further evidence of the belief that children's feces are harmless.

Further investigation is recommended to learn about barriers to handwashing at all appropriate times. It seems from the good coverage data that access to water should not be a barrier. The baseline also reported that the vast majority of families have soap for hands at the place of washing but over a quarter of women admitted they don't always use soap when washing their hands.

Gender and Intra-Familial Dynamics

In modern Kyrgyzstan, gender and women's roles show the influence of not only traditional Kyrgyz pastoral culture, but also the centuries of living in mixed communities with Russians, and the Soviet influence on education for women and working women. According to the DHS and the SPRING baseline, 99 percent of women have at least a high school education. In Jumgal, 46 percent have post-secondary training or education, while in Jalalabad, 35 percent of women interviewed have post-secondary training or education. The baseline found that about one quarter of women interviewed work in some profession, a relatively high percentage considering that most of the target area is rural with few available job opportunities.

The formative research found distinctions between Jumgal and Upper Jalalabad with Lower Jalalabad in terms of women's roles in agricultural work. In Lower Jalalabad, women report working long hours in their family fields or for other farms, especially during planting and harvest seasons. In the other two areas, where agriculture is primarily livestock-raising, women reported spending little or no time on agricultural activities other than caring for poultry and livestock kept near the house such as a milk cow.

In all areas, caring for vegetable garden is primarily the responsibility of women, with men taking an active role in preparing the soil and harvesting. Decisions about what to plant and sell are often made jointly, but women report that they usually decide by themselves or with other women in the household. Decisions about selling large livestock are usually made exclusively by men, who are also responsible for care of the large animals.

Housework is considered the domain of women, however, fetching water was observed to be almost entirely the responsibility of young boys. Except in some very conservative families, women have independence in mobility. In focus groups, men reported that it is up to a woman to decide whether to seek health care for herself or a sick child, but in most families, she would have to discuss it with her husband because she would need to ask him for money. Men feel it is their role to handle family finances.

Some newly married couples live with his parents until they can afford a house of their own. The mother-in-law has primary decision-making responsibility about what foods to purchase and prepare, although she may expect the young woman to complete food preparation. Older women also influence child care decisions within the house, as noted above in the discussion of child feeding practices.

Among those of Kyrgyz ethnicity, young men must pay a bride price, either in cash or livestock. In return, the young woman's family must provide a dowry of a household start-up package, which will include furniture, kitchen utensils and bedding, and may include appliances such as a stove or small washing machine. Thus, the number of assets a young couple has may be a reflection of her parents' affluence or the size of bride price they received rather than a measure of wealth of the young couple itself.

Health Facility Assessment Results

The purpose of the HFAs was to obtain an overview of conditions and of supplies available at health facilities, particularly items related to providing nutrition-related services. The HFA was conducted using a checklist for observation and reviewing patient records. Whichever health worker was available to show the researcher around was also given a brief written exam consisting of seven questions to assess practical knowledge. The tools used for the HFA can be found in Annex C. The SPRING staff member in charge of this part of the research, a physician, has many years of experience conducting similar assessments and monitoring health facilities throughout Kyrgyzstan.

In total, this assessment included 23 health facilities of all sizes. These included five maternity centers, six Family Medical Centers (the main referral centers for a district), and eight lower level centers called Family Group Practice and two rural health posts called FAPs. The sample was purposive; these medical facilities were located in or adjacent to the sites selected for other formative research activities.

The health facilities visited had most necessary equipment along with growth charts. All of the health facilities had some kind of toilet facility, but 9 of the 23 were rated as being in very poor condition. Six of the health facilities in the HFA did not have running water inside, and five others did not have a functioning handwashing station. Almost all of them had the handwashing protocol displayed and soap was available, even if there was not water on hand. While the observation guide did not document this, several of the health facilities did not have central heat, while others had coal stoves in one room and still others had only small electric heaters in some rooms.

None of the health facilities had handout materials on any nutrition topics nor audio visual equipment. Several had nutrition-related posters on the wall, but some were outdated and others were not adapted to the Kyrgyzstan context. Only two health facilities had the existing anemia treatment protocol for pregnant women and five had the protocol for anemia in children. None of the health facilities had iron supplements available to distribute free of charge. Only the Jumgal health facilities had Gulyzak (a micronutrient powder) fully stocked and available for distribution (provided by the Swiss Red Cross.)

The review of clinical records for pregnant women revealed that they are neither being prescribed iron supplements according to the protocol, nor is there the recommended follow up for those who are told they should purchase iron. More details are provided in a separate formative research report on anemia.

In general, there are deficits in record-keeping, although records are much better kept in Jalalabad than in Jumgal. Of particular note was one Family Medical Center that had no records for children under age two. Additional investigation will be needed to identify the barriers to keeping complete and accurate records. The results of the HFA are shown in the chart in Annex H. More detailed descriptions are available in Russian for staff use upon request.

An additional component of the HFA consisted of giving a short training needs assessment to one or more available professional staff at each facility. This short exam existed of seven practical questions as shown in Annex C. The exam was administered to 67 health workers including 42 nurses, 6 gynecologists, 4 feldshers (medics), and 5 family doctors. The average score was 2.17 out of 7 points possible, and gynecologists and doctors did not score better than nurses or feldshers. All tested had difficulty with the two questions related to prevention of anemia and counseling on the side effects of taking iron supplements. A surprising number of the respondents could not explain counseling messages for pregnant women nor explain the purpose of using iodized salt. They all scored relatively better on recommendations for breastfeeding and complementary feeding.

Recommendations

1. Implement IYCF, BFHI, and anemia training, as stated in the project work plan, for all health workers in the target areas. Follow up with supportive supervision and mentoring to ensure institutionalization of protocols, and new skill development.

2. Conduct supportive supervision jointly with district health officials, with particular attention to improving charting/record keeping.

3. Collaborate with local governments and district health officials to ensure that each health facility has a clean, functional latrine and that the number of latrines or toilets is appropriate for the number of staff and patients.

4. Work with local governments and district health officials to provide handwashing stations and a consistent supply of clean water.

5. Ensure that the Strategic Behavior Communication strategy includes ample nutrition materials for distribution or display at health facilities.

6. Assist the Ministry of Health to develop a new anemia protocol, including designing a training for health workers on implementing the protocol, and a system for distributing iron-folic acid, which has already been procured along with MNP (Gulyzak) for Jalalabad.

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According to the 2012 Demographic and Health Survey (DHS), 18 percent of children in the Kyrgyz Republic under the age of five are stunted, while 43 percent of children ages six to 59 months and 35 percent of women of reproductive age are anemic.

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Trendy foods are a bad influence on the youth because they are usually splurge foods.

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When habits are started

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you may think that the advertisement looks delicious, but then you get the actual thing. They don't have the same ingredient.

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How and when are habits established

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Think about something it took you a really long time to learn, like how to parallel park. At first, parallel parking was difficult and you had to devote a lot of mental energy to it. But after you grew comfortable with parallel parking, it became much easier - almost habitual, you could say.

Parallel parking, gambling, exercising, brushing your teeth and every other habit-forming activity all follow the same behavioral and neurological patterns, says New York Times business writer Charles Duhigg. His new book The Power of Habit explores the science behind why we do what we do - and how companies are now working to use our habit formations to sell and market products to us.
How Habits Form
It turns out that every habit starts with a psychological pattern called a "habit loop," which is a three-part process. First, there's a cue, or trigger, that tells your brain to go into automatic mode and let a behavior unfold.

"Then there's the routine, which is the behavior itself," Duhigg tells Fresh Air's Terry Gross. "That's what we think about when we think about habits."

The third step, he says, is the reward: something that your brain likes that helps it remember the "habit loop" in the future.

Neuroscientists have traced our habit-making behaviors to a part of the brain called the basal ganglia, which also plays a key role in the development of emotions, memories and pattern recognition. Decisions, meanwhile, are made in a different part of the brain called the prefrontal cortex. But as soon as a behavior becomes automatic, the decision-making part of your brain goes into a sleep mode of sorts.

"In fact, the brain starts working less and less," says Duhigg. "The brain can almost completely shut down. ... And this is a real advantage, because it means you have all of this mental activity you can devote to something else."

That's why it's easy - while driving or parallel parking, let's say - to completely focus on something else: like the radio, or a conversation you're having.

"You can do these complex behaviors without being mentally aware of it at all," he says. "And that's because of the capacity of our basal ganglia: to take a behavior and turn it into an automatic routine."

Studies have shown that people will perform automated behaviors - like pulling out of a driveway or brushing teeth - the same way every single time, if they're in the same environment. But if they take a vacation, it's likely that the behavior will change.

"You'll put your shoes on in a different order without paying any attention to it," he says, "because once the cues change, patterns are broken up."

That's one of the reasons why taking a vacation is so relaxing: It helps break certain habits.

"It's also a great reason why changing a habit on a vacation is one of the proven most-successful ways to do it," he says. "If you want to quit smoking, you should stop smoking while you're on a vacation - because all your old cues and all your old rewards aren't there anymore. So you have this ability to form a new pattern and hopefully be able to carry it over into your life."
Marketing Habits
It's not just individual habits that become automated. Duhigg says there are studies that show organizational habits form among workers working for the same company. And companies themselves exploit habit cues and rewards to try to sway customers, particularly if customers themselves can't articulate what pleasurable experience they derive from a habit.

"Companies are very, very good - better than consumers themselves - at knowing what consumers are actually craving," says Duhigg.

As an example, he points to Febreeze, a Proctor & Gamble fabric odor eliminator that initially failed when it got to the market.

"They thought that consumers would use it because they were craving getting rid of bad scents," he says. "And it was a total flop. People who had 12 cats and their homes smelled terrible? They wouldn't use Febreeze."

That's when Proctor & Gamble reformulated Febreeze to include different scents.

"As soon as they did that, people started using it at the end of their cleaning habits to make things smell as nice as they looked," he says. "And what they figured out is that people crave a nice smell when everything looks pretty. Now, no consumer would have said that. ... But companies can figure this out, and that's how they can make products work."

Companies can also figure out how to get consumers to change their own habits and form new ones associated with their products or stores. The megastore Target, for example, tries to target pregnant women, says Duhigg, in order to capture their buying habits for the next few years.

The biggest moment of flexibility in our shopping habits is when we have a child.

"The biggest moment of flexibility in our shopping habits is when we have a child," he says, "because all of your old routines go out the window, and suddenly a marketer can come in and sell you new things."

Analysts at Target collect "terabytes of information" on its shoppers. They have figured out that women who buy certain products - vitamins, unscented lotions, washcloths - might be pregnant and then can use that information to jump-start their marketing campaign.

This can get tricky: One father was upset after receiving coupons for baby products in the mail from Target addressed to his teenage daughter.

"He went in and said, 'My daughter is 16 years old. Are you trying to encourage her to get pregnant?' and the manager apologizes," Duhigg says. "The manager calls a couple of days later ... and the father says, ' I need to apologize. ... I had a conversation with my daughter, and it turns out there's some things going on in my house that I wasn't aware of. She's due in August.' So Target figured it out before her dad did."

Interview Highlights
On breaking habits
"What we know from lab studies is that it's never too late to break a habit. Habits are malleable throughout your entire life. But we also know that the best way to change a habit is to understand its structure - that once you tell people about the cue and the reward and you force them to recognize what those factors are in a behavior, it becomes much, much easier to change."
On his bad habits
"I felt like I had a lot of habits that I was powerless over. ... I have a 3-year-old and a 10-month-old. And I remember when my 3-year-old was 1 1/2 or 2. I was writing the book. We would feed him chicken nuggets or other stuff for dinner, which was the only stuff he would eat. And it was impossible for me to stop from reaching over and grabbing his chicken nuggets. It was a struggle every night not to eat his dinner because a 2-year-old dinner is designed to taste delicious and to disintegrate into your mouth into carbs and sugar. And so, I was really interested in this, and I wanted to exercise more and I wanted to be more productive at work."
On rewards
"The weird thing about rewards is that we don't actually know what we're actually craving."
On spirituality and habits
"When [Alcoholics Anonymous] started, there was no scientific basis to it whatsoever. In fact, there's no scientific basis to AA. The 12 steps that are kind of famous? The reason why there's 12 of them is because the guy who came up with them - who wrote them one night while he was sitting on his bed - he chose them because there's 12 apostles. There's no real logic to how AA was designed. But the reason why AA works is because it essentially is this big machine for changing the habits around alcohol consumption and giving people a new routine, rather than going to a bar or drink. ... It doesn't seem to work if people do it on their own. ... At some point, if you're changing a really deep-seated behavior, you're going to have a moment of weakness. And at that moment, if you can look across a room and think, 'Jim's kind of a moron. I think I'm smarter than Jim. But Jim has been sober for three years. And if Jim can do it, I can definitely do it,' that's enormously powerful."

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Habits: How They Form And How To Break Them

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Every habit-forming activity follows the same behavioral and neurological patterns, says New York Times business writer Charles Duhigg. His new book The Power of Habit explores the science behind why we do what we do - and how companies are working to use our habits to market products to us.

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How food habits were established

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When it comes to establishing healthy eating habits, both the parent and the child have resonsibilities.

Parent's Responsibility

Providing a variety of foods from which your child can choose

Parents provide appropriate food selections for meals and snacks to meet their children's needs for growth and development.

Developing a schedule of meal and snack times for your child

Children need to eat meals and snacks. Because their stomachs are so small, children need to have five to six small frequent meals, or three meals a day with two or three snacks between meals. Having evenly spaced planned meals and snacks helps you avoid questions like, "When are we eating?" and "I'm hungry, when are we having dinner?"

Providing an appropriate mealtime environment

Children should focus on food during meal and snack times. Eating at the table prevents the child from confusing eating with playtime. Distractions, like watching television or playing games at the table, should be avoided.

Child's Responsibility

Deciding what to eat of the foods offered

Only your child knows if he or she is hungry. If it is mealtime and your child chooses not to eat, don't try to make him or her eat. Don't only cook the foods that your child likes or make a substitute meal if he or she chooses not to eat the meal that you have prepared.

Deciding how much to eat of the foods offered

You should not make your child eat. Your child knows how much he or she needs to eat. Allow your child's hunger to regulate the amount of food he or she eats.

Pickiness or refusal to eat often results from inappropriate tactics such as force feeding, bribing and punishing. If parents eat a variety of healthy foods, the child will be more likely to try and like a variety of foods.

Studies show that children generally will grow up to eat the way that their parents eat. Predictable meal and snack times, a pleasant atmosphere and a wholesome balanced diet will provide your child with a foundation of good eating habits for her future. In addition, planning ahead will ensure that you and your child will have tasty food that is good for both of you.

What Not to Worry About

Wariness about new foods

Though it may take time, your child will learn to like a variety of foods. Children will repeatedly examine foods that they are offered, with or without trying the food items. Eventually, the child may try the food by putting it in his or her mouth and then taking it out again. These actions are normal. Avoid punishing or scolding a child for these behaviors. A child may be offered a food 10 to 15 times before swallowing it and then may only eat it occasionally.

Eating habits that change daily

Children will often eat a lot of food one day and not so much the next day. The foods the child likes also can change not only from day to day, but also from meal to meal. Some days, your child may eat a lot in the morning and not much else for the rest of the day. These habits are usually normal. It is important for parents not to focus on these fluctuations.

Appetite and appetite changes

Children know how much they need to eat and are sensitive to their appetites and appetite changes. Children also grow differently and have individual needs and eating habits. Children often eat the majority of their food early in the day. Dinner may be their smallest meal. In addition, children have different levels of activity on a day-to-day basis. Activity can affect the amount of food the child may eat on that day. It's important to keep in mind that children know when they're hungry and when they're not.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.

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When it comes to establishing healthy eating habits, both the parent and the child have resonsibilities. Providing a variety of foods from which your child can choose Parents provide appropriate food selections for meals and snacks to meet their children's needs for growth and development.

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Factors that may influence a persons diet.

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A Unique Diet for You

You know that you are a unique person. There are so many things that set you apart from a huge chunk of people - age, gender, culture, athletic ability, and so much more. When combined, those differences create a truly unique person of which there is no other but you in this world.

I think that's pretty nifty. These differences are also important because they influence appropriate dietary choices. Just as an example you can certainly agree with, pregnant women have very different needs than your average male office worker. This, and so much more, will be touched on as we explore some of the many factors that influence dietary choices.

Gender and Diet

They say that men are from Mars and women are from Venus. In some respects, men and women think differently, act differently, and have varying needs even in the same situation! Dietary habits are not immune from this observation.

Let's think of some examples together using averages we know to be true. Women are smaller than men. This means women need fewer calories than men, meaning they need to eat less food. If an average woman was to consume the same amount of calories as the average man, she'd be more likely to gain weight - all else equal, of course.

But there's something very important here. There's a danger in consuming less food and thus, fewer calories willy-nilly. The right kind of food contains nutrients that go beyond just calories. There are vitamins and minerals within our food. That is why a woman should focus more on consuming nutrient-dense food, like complex carbohydrates, in order to ensure important vitamins and minerals are gained while still eating fewer calories than a man.

Think of it this way: A doughnut has a ton of calories, but is not very nutritious. A whole grain cereal may have the same amount, or even fewer calories than the doughnut, but is rich in vitamins, minerals, and fiber.

Importantly, two nutrients, known as calcium and iron, are of special concern for women. Calcium is a mineral that helps to build strong bones and iron is a mineral that helps to form red blood cells. Calcium is necessary because women are more likely to develop osteoporosis, a condition that leads to fragile bones. Iron is important for menstruating women because it helps to avoid iron deficiency anemia. Anemia is a low red blood cell count.

But I don't want to leave out the guys here. Although men generally consume more food and thus are less likely to suffer from nutritional deficiencies, there are still plenty of problems associated with this type of diet. Eating too much red meat is known to give guys a lot of trouble with their hearts and arteries. This predisposes a man to a heart attack.

Because some men eat a lot of food in general, even for their body size, obesity is a real risk, and this can lead to arthritis, diabetes, and, of course, heart disease. Thus, just like women, men need to focus on eating the right kinds of calories made up of fruits, vegetables, and whole grains while holding back on grilling every type of meat known to man.

Culture and Diet

But dietary influences go beyond the battle of the sexes. Cultural differences are important to note. Some cultures and even religions emphasize a vegetarian or even vegan diet. A vegan diet refers to a diet that excludes meat and animal products, such as milk and eggs. Such cultural, religious, or purely personal dietary choices are fine so long as they are made with care and consideration. For instance, vegetarians need to seek out protein sources other than meat in order to stay healthy. This can include eggs, milk, tofu, beans, and so forth.

Age and Diet

In addition to culture and gender, age plays an important role in influencing dietary choices. As a person ages, certain dietary modifications may need to be taken. Since the elderly tend to move around less, they need to consume fewer calories to maintain a healthy weight. Because their digestive system doesn't work as well as before, elderly people may need to supplement their diets with vitamin B12 and fiber.

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factors that influence dietary choices: gender

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culture & other issues - video & lesson transcript | study.com

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Factors that Influence Dietary Choices: Gender, Culture & Other Issues - Video & Lesson Transcript | Study.com

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You know that you are a unique person. There are so many things that set you apart from a huge chunk of people - age, gender, culture, athletic ability, and so much more. When combined, those differences create a truly unique person of which there is no other but you in this world.

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In America we are told we should eat healthy and be skinny but we are bombarded with junk food and food advertisements that have mixed messages. Be SKINNY but order a SUPERSIZE HAMBURGER AND FRY.

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Ways to change your eating habits>

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Centers for Disease Control and Prevention

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Permanently improve your eating habits with this thoughtful approach.

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This article tell how the way you eat or don't eat can affect your health significantly.

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Taking Charge of Your Health & Wellbeing

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How Does Diet Impact Health? | Taking Charge of Your Health & Wellbeing

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A healthy diet gives your body the nutrients it needs to perform physically, maintain wellness, and fight disease.

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Healthy vs Unhealthy steaks
https://www.theguardian.com/lifeandstyle/2013/mar/11/how-bad-is-steak-for-you

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You can still eat the things you want such as pizza . All you have to do is replace some ingredients and just eat foods that will replenish your body.

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How Your Eating Habits Affect Your Health. A new study shows how the things you eat can influence your risk of dying from heart disease, stroke, or type 2 diabetes. ... A healthy diet also includes lean meats, poultry, fish, beans, eggs, and nuts. It limits saturated and trans fats, sodium, and added sugar

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Factors that influence a persons diet are knowledge of nutrition and cultural and social meetings, and by that it means that if you don't know how to read nutrition labels you don't know what nutrients you are taking in.

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https://www.healthlinkbc.ca/health-topics/ug2146

Is it an emergency?

If you or someone in your care has chest pains, difficulty breathing, or severe bleeding, it could be a life-threatening emergency. Call 9-1-1 or the local emergency number immediately.

If you are concerned about a possible poisoning or exposure to a toxic substance, call Poison Control now at 1-800-567-8911.

Thanks to our partners and endorsers:

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encounter for dietary surveillance and counseling

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Healthy Eating: Influences on Eating Behaviour

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https://www.healthlinkbc.ca/health-topics/ug2146 Is it an emergency? If you or someone in your care has chest pains, difficulty breathing, or severe bleeding, it could be a life-threatening emergency. Call 9-1-1 or the local emergency number immediately. If you are concerned about a possible poisoning or exposure to a toxic substance, call Poison Control now at 1-800-567-8911.

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How to determine your food choices?

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Given the priority for population dietary change there is a need for a greater understanding of the determinants that affect food choice. This review examines the major influences on food choice with a focus on those that are amenable to change and discusses some successful interventions.

1. Major determinants of food choice

The key driver for eating is of course hunger but what we choose to eat is not determined solely by physiological or nutritional needs. Some of the other factors that influence food choice include:

Biological determinants such as hunger, appetite, and taste

Economic determinants such as cost, income, availability

Physical determinants such as access, education, skills (e.g. cooking) and time

Social determinants such as culture, family, peers and meal patterns

Psychological determinants such as mood, stress and guilt

Attitudes, beliefs and knowledge about food

The complexity of food choice is obvious from the list above, which is in itself not exhaustive. Food choice factors also vary according to life stage and the power of one factor will vary from one individual or group of people to the next. Thus, one type of intervention to modify food choice behaviour will not suit all population groups. Rather, interventions need to be geared towards different groups of the population with consideration to the many factors influencing their decisions on food choice.

1.1 Biological determinants of food choice

Hunger and satiety

Our physiological needs provide the basic determinants of food choice. Humans need energy and nutrients in order to survive and will respond to the feelings of hunger and satiety (satisfaction of appetite, state of no hunger between two eating occasions). The central nervous system is involved in controlling the balance between hunger, appetite stimulation and food intake.

The macro-nutrients i.e. carbohydrates, proteins and fats generate satiety signals of varying strength. The balance of evidence suggests that fat has the lowest satiating power, carbohydrates have an intermediate effect and protein has been found to be the most satiating.

The energy density of diets has been shown to exert potent effects on satiety; low energy density diets generate greater satiety than high energy density diets. The high energy density of high-fat and/or high-sugar foods can also lead to 'passive overconsumption', where excess energy is ingested unintentionally and without the consumption of additional bulk.

An important satiety signal may be the volume of food or portion size consumed. Many people are unaware of what constitutes appropriate portion sizes and thus inadvertently consume excess energy.

Palatability

Palatability is proportional to the pleasure someone experiences when eating a particular food. It is dependent on the sensory properties of the food such as taste, smell, texture and appearance. Sweet and high-fat foods have an undeniable sensory appeal. It is not surprising then that food is not solely regarded as a source of nourishment but is often consumed for the pleasure value it imparts.

The influence of palatability on appetite and food intake in humans has been investigated in several studies. There is an increase in food intake as palatability increases, but the effect of palatability on appetite in the period following consumption is unclear. Increasing food variety can also increase food and energy intake and in the short term alter energy balance. However, effects on long-term energy regulation are unknown.

Sensory aspects

'Taste' is consistently reported as a major influence on food behaviour. In reality 'taste' is the sum of all sensory stimulation that is produced by the ingestion of a food. This includes not only taste per se but also smell, appearance and texture of food. These sensory aspects are thought to influence, in particular, spontaneous food choice.

From an early age, taste and familiarity influence behaviour towards food. A liking for sweetness and a dislike for bitterness are considered innate human traits, present from birth. Taste preferences and food aversions develop through experiences and are influenced by our attitudes, beliefs and expectations.

1.2 Economic and physical determinants of food choice

Cost and accessibility

There is no doubt that the cost of food is a primary determinant of food choice. Whether cost is prohibitive depends fundamentally on a person's income and socio-economic status. Low-income groups have a greater tendency to consume unbalanced diets and in particular have low intakes of fruit and vegetables. However, access to more money does not automatically equate to a better quality diet but the range of foods from which one can choose should increase.

Education and Knowledge

1.3 Social determinants of food choice

Influence of social class

What people eat is formed and constrained by circumstances that are essentially social and cultural. Population studies show there are clear differences in social classes with regard to food and nutrient intakes. Poor diets can result in under- (micronutrients deficiency) and over-nutrition (energy over consumption resulting in overweight and obesity); problems that face different sectors of society, requiring different levels of expertise and methods of intervention.

Cultural influences

Cultural influences lead to the difference in the habitual consumption of certain foods and in traditions of preparation, and in certain cases can lead to restrictions such as exclusion of meat and milk from the diet. Cultural influences are however amenable to change: when moving to a new country individuals often adopt particular food habits of the local culture.

Social context

Social influences on food intake refer to the impact that one or more persons have on the eating behaviour of others, either direct (buying food) or indirect (learn from peer's behaviour), either conscious (transfer of beliefs) or subconscious. Even when eating alone, food choice is influenced by social factors because attitudes and habits develop through the interaction with others. However, quantifying the social influences on food intake is difficult because the influences that people have on the eating behaviour of others are not limited to one type and people are not necessarily aware of the social influences that are exerted on their eating behaviour.

Social support can have a beneficial effect on food choices and healthful dietary change. For example, social support has been found to be a strong predictor for fruit and vegetable consumption among adults. Social support may enhance health promotion through fostering a sense of group belonging and helping people to be more competent and self-efficacious.

The family is widely recognised as being significant in food decisions. Research shows the shaping of food choices taking place in the home. Because family and friends can be a source of encouragement in making and sustaining dietary change, adopting dietary strategies which are acceptable to them may benefit the individual whilst also having an effect on the eating habits of others.

Social setting

1.4 Meal patterns

People have many different eating occasions daily, the motivations for which will differ from one occasion to the next. Most studies investigate the factors that influence habitual food choice but it may be useful to investigate what influences food choice at different eating occasions.

The effects of snacking on health have been debated widely. Evidence shows that snacking can have effects on energy and nutrient intakes but not necessarily on body mass index. However, individuals with normal weight or overweight may differ in their coping strategies when snack foods are freely available and also in their compensatory mechanisms at subsequent meals. Moreover, snack composition may be an important aspect in the ability of individuals to adjust intake to meet energy needs.

Helping young adults to choose healthy snack choices poses a challenge to many health professionals. In the home, rather than forbidding unhealthy snacks, a more positive approach may be the introduction of healthy snack options over time. Moreover, healthy food choices outside the home also need to be made more readily available.

1.5 Psychological factors

Stress

Psychological stress is a common feature of modern life and can modify behaviours that affect health, such as physical activity, smoking or food choice.

The influence of stress on food choice is complex not least because of the various types of stress one can experience. The effect of stress on food intake depends on the individual, the stressor and the circumstances. In general, some people eat more and some eat less than normal when experiencing stress.

The proposed mechanisms for stress induced changes in eating and food choice are motivational differences (reduced concern about weight control), physiological (reduced appetite caused by the processes associated with stress) and practical changes in eating opportunities, food availability and meal preparation.

Studies also suggest that if work stress is prolonged or frequent, then adverse dietary changes could result, increasing the possibility of weight gain and consequently cardiovascular risk.

Mood

Hippocrates was the first to suggest the healing power of food, however, it was not until the middle ages that food was considered a tool to modify temperament and mood. Today it is recognised that food influences our mood and that mood has a strong influence over our choice of food.

Interestingly, it appears that the influence of food on mood is related in part to attitudes towards particular foods. The ambivalent relationship with food - wanting to enjoy it but conscious of weight gain is a struggle experienced by many. Dieters, people with high restraint and some women report feeling guilty because of not eating what they think they should. Moreover, attempts to restrict intake of certain foods can increase the desire for these particular foods, leading to what are described as food cravings.

Women more commonly report food cravings than do men. Depressed mood appears to influence the severity of these cravings. Reports of food cravings are also more common in the premenstrual phase, a time when total food intake increases and a parallel change in basal metabolic rate occurs.

Thus, mood and stress can influence food choice behaviour and possibly short and long term responses to dietary intervention.

2. Eating disorders

Eating behaviour, unlike many other biological functions, is often subject to sophisticated cognitive control. One of the most widely practised forms of cognitive control over food intake is dieting.

Many individuals express a desire to lose weight or improve their body shape and thus engage in approaches to achieve their ideal body mass index. However, problems can arise when dieting and/or exercise are taken to extremes. The aetiology of eating disorders is usually a combination of factors including biological, psychological, familial and socio-cultural. The occurrence of eating disorders is often associated with a distorted self-image, low self-esteem, non-specific anxiety, obsession, stress and unhappiness.

Treatment of an eating disorder generally requires weight stabilisation and one-to-one psychotherapy. Prevention is more difficult to define but suggestions include avoidance of child abuse; avoidance of magnifying diet and health issues; showing affection without over-controlling; not setting impossible standards; rewarding small attainments in the present; encouraging independence and sociability.

3. Consumer attitudes, beliefs, knowledge and optimistic bias

Consumer attitudes and beliefs

In both the areas of food safety and nutrition, our understanding of consumers' attitudes are poorly researched. A better understanding of how the public perceive their diets would help in the design and implementation of healthy eating initiatives.

The Pan-European Survey of Consumer Attitudes to Food, Nutrition and Health found that the top five influences on food choice in 15 European member states are 'quality/freshness' (74%), 'price' (43%), 'taste' (38%), 'trying to eat healthy' (32%) and 'what my family wants to eat' (29%). These are average figures obtained by grouping 15 European member states results, which differed significantly from country to country. In the USA the following order of factors affecting food choices has been reported: taste, cost, nutrition, convenience and weight concerns.

In the Pan-European study, females, older subjects, and more educated subjects considered 'health aspects' to be particularly important. Males more frequently selected 'taste' and 'habit' as main determinants of their food choice. 'Price' seemed to be most important in unemployed and retired subjects. Interventions targeted at these groups should consider their perceived determinants of food choice.

Attitudes and beliefs can and do change; our attitude to dietary fat has changed in the last 50 years with a corresponding decrease in the absolute amount of fat eaten and a change in the ratio of saturated to unsaturated fat.

Optimistic bias

There is a low level of perceived need among European populations to alter their eating habits for health reasons, 71% surveyed believing that their diets are already adequately healthy. This high level of satisfaction with current diets has been reported in Australian, American and English subjects.

If people believe that their diets are already healthy it may be unreasonable to expect them to alter their diets, or to consider nutrition/healthy eating as a highly important factor when choosing their food. Although these consumers have a higher probability of having a healthier diet than those who recognise their diet is in need of improvement, they are still far short of the generally accepted public health nutrition goals. It is also unlikely that these groups will be motivated further by dietary recommendations. Hence, future interventions may need to increase awareness among the general population that their own diet is not wholly adequate in terms of, for example fat, or fruit and vegetable consumption. For those who believe their diets to be healthy it has been suggested that if their beliefs about outcomes of dietary change can be altered, their attitudes may become more favourable and they therefore may be more likely to alter their diets. Thus, a perceived need to undertake change is a fundamental requirement for initiating dietary change.

4. Barriers to dietary and lifestyle change

Focus on cost

Household income and the cost of food is an important factor influencing food choice, especially for low-income consumers. The potential for food wastage leads to a reluctance to try 'new' foods for fear the family will reject them. In addition, a lack of knowledge and the loss of cooking skills can also inhibit buying and preparing meals from basic ingredients.

Time constraints

Lack of time is frequently mentioned for not following nutritional advice, particularly by the young and well educated. People living alone or cooking for one seek out convenience foods rather than cooking from basic ingredients. This need has been met with a shift in the fruit and vegetables market from loose to prepacked, prepared and ready-to-cook products. These products are more expensive than loose products but people are willing to pay the extra cost because of the convenience they bring. Developing a greater range of tasty, convenient foods with good nutritional profiles offers a route to improving the diet quality of these groups.

5. Models for changing behaviour

Health Behavioural Models

Understanding how people make decisions about their health can help in planning health promotion strategies. This is where the influence of social psychology and its associated theory-based models play a role. These models help to explain human behaviour and in particular to understand how people make decisions about their health. They have also been used to predict the likelihood that dietary behaviour change will occur. This section focuses on a select few.

The Health Belief Model (HBM) and the Protection Motivation Theory

The Theory of Reasoned Action (TRA) and the Theory of Planned Behaviour (TPB)

1. attitudes,

2. perception of social pressure to perform the behaviour and

3. perceived control over the behaviour.

In dietary studies TPB/TRA enables a comparison of the strength of influences upon individuals and between sample groups and can be used to build an understanding of the determinants of food choice. The TRA has been successful in explaining behaviours such as fat, salt and milk intake. The TPB model was also used to help explain attitudes and beliefs about starchy foods in the UK.

Stage classification for health-related behaviour

The Stages of Change model developed by Prochaska and co-workers suggests that health related behaviour change occurs through five separate stages. These are pre-contemplation, contemplation, preparation, action and maintenance. The model assumes that if different factors influence transitions at different stages, then individuals should respond best to interventions tailored to match their stage of change.

The Stages of Change model, in contrast to the other models discussed, has proven to be more popular for use in changing behaviour rather than in explaining current behaviour. This is probably because the model offers practical intervention guidance that can be taught to practitioners. In addition, large random samples can be tested with messages tailored to the person's stage of readiness to change.

It has been suggested that a stage model may be more appropriate for simpler more discrete behaviours such as eating five servings of fruit and vegetables every day, or drinking low-fat milk (food-based goals) than for complex dietary changes such as low-fat eating (nutrient-based goal).

Presently, no one theory or model sufficiently explains and predicts the full range of food-choice behaviours. Models in general should be viewed as a means to understanding the factors influencing individual decisions and behaviour. Despite the number of models of behaviour change, they have been employed in relatively few nutrition interventions; the Stages of Change model being the most popular. However, the best test of this model, whether stage-matched dietary interventions outperform standardised approaches, has yet to be performed.

6. Changing food behaviour: successful interventions

Dietary change is not easy because it requires alterations in habits that have been built up over a life-time. Various settings such as schools, workplaces, supermarkets, primary care and community based studies have been used in order to identify what works for particular groups of people. Although results from such trials are difficult to extrapolate to other settings or the general public, such targeted interventions have been reasonably successful, illustrating that different approaches are required for different groups of people or different aspects of the diet.

Interventions in supermarket settings are popular given this is where the majority of the people buy most of their food. Screening, shop tours and point-of-purchase interventions are ways in which information can be provided. Such interventions are successful at raising awareness and nutrition knowledge but their effectiveness of any real and long-term behaviour change is unclear at present.

Schools are another obvious intervention setting because they can reach the students, their parents and the school staff. Fruit and vegetable intake in children has been increased through the use of tuck shops, multimedia and the internet and when children get involved in growing, preparing and cooking the food they eat. Moreover, covert changes to dishes to lower fat, sodium and energy content improved the nutritional profile of school dinners without losing student participation in the school lunch programme.

Workplace interventions can also reach large numbers of people and can target those at risk. Increasing availability and appeal of fruit and vegetables proved successful in worksite canteens and price reductions for healthier snacks in vending machines increased sales. Thus, the combination of nutrition education with changes in the workplace are more likely to succeed particularly if interactive activities are employed and if such activities are sustained for long periods.

Tackling several dietary factors simultaneously such as reducing dietary fat and increasing fruit and vegetables, has proved effective in the primary care setting. Behavioural counselling in conjunction with nutrition counselling seems most effective in such settings although the cost implications of training primary care professionals in behaviour counselling are unclear at this time. Educational and behavioural strategies have also been used in public health/ community settings, which have been shown to increase fruit and vegetable intake.

7. Conclusion

There are many influences on food choice which provide a whole set of means to intervene into and improve people's food choices. There are also a number of barriers to dietary and lifestyle change, which vary depending on life stages and the individual or group of people in question.

It is a major challenge both to health professionals and to the public themselves to effect dietary change. Different strategies are required to trigger a change in behaviour in groups with different priorities. Campaigns that incorporate tailored advice that include practical solutions as well as environmental change are likely to succeed in facilitating dietary change.
Reviewed by Dr France Bellisle, INRA, France
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The Factors That Influence Our Food Choices

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This article explains the major factors that influence our food choices with a focus on those we can change and discusses some successful interventions.

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Where do food habits originate?

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The History of Man's Eating Habits | Official web site of the Montignac Method

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The Montignac.com website exposes the nutritional principles of an innovating and non restrictive diet. Michel Montignac was the first to use the glycemic index for weight loss. He pioneered a new way of thinking of weight control and healthy eating.

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Find healthy choices for snacks and plan ahead:

If you are in the habit of eating candy at the end of the day for energy, try having a cup (240 milliliters) of herbal tea and a small handful of almonds. Or take a quick walk when you are feeling an energy low.

Eat fruit and yogurt in the mid-afternoon about 3 or 4 hours after lunch.

Control your portion sizes. It is hard to eat only a few chips or other tempting foods when there is a lot in front of you. Take only a small portion and put the rest away. Eat on a plate or in a bowl instead of straight out of a bag.

Eat slowly:

Put down your fork between bites.

Wait until you have swallowed your mouthful of food before taking the next bite.

Eating too quickly leads to overeating when the food you have eaten has not yet reached your stomach and told your brain you are full. You will know you are eating too quickly if you feel stuffed about 20 minutes after you stop eating.

Eat only when you are hungry:

Eating when you feel worried, tense, or bored also leads to overeating. Instead, call a friend or go for a walk to help you feel better.

Give your body and your brain time to relax from the stress of daily life. Take a mental or physical break to help you feel better without turning to food as a reward.

Make healthier, nutrient-rich choices:

Replace your candy dish with a bowl of fruit or nuts.

When you do have unhealthy foods in your house, put them in a place that is hard for you to reach rather than out on the counter.

Plan your meals:

Know what you will eat ahead of time so you can avoid buying unhealthy foods (impulse buying) or eating at fast-food restaurants.

Plan your dinners at the beginning of the week so you can prepare healthy, well-balanced meals each evening.

Prepare some dinner components ahead of time (such as chopping vegetables). This will allow you to put together a healthy meal more quickly at the end of the day.

Breakfast sets the tone for the day. A hearty, healthy breakfast will give your body the energy it needs to get you to lunch. If you are not hungry when you wake up, you could try a glass of milk or a small fruit and dairy-based smoothie.

Plan a good lunch that will satisfy you, and a healthy afternoon snack that will keep you from becoming too hungry before dinner time.

Avoid skipping meals. Missing a regular meal or snack often leads to overeating or making unhealthy choices later.

Once you have changed 1 or 2 old unhealthy habits, try changing 1 or 2 more.

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Eating habits and behaviors: MedlinePlus Medical Encyclopedia

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Food gives our bodies the energy we need to function. Food is also a part of traditions and culture. This can mean that eating has an emotional component as well. For many people, changing eating habits

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What are food habits?

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There are so many "healthy" eating diets, trends, tricks and new food miracles hyped in the media that it can be quite stressful to follow. Some of them encourage complete opposite food groups, like fat and sugar. Some have emphasis on a specific food group, and others offer one solution to fix all your problems.

At the end of the day, the most important thing is to notice what they all have in common: eat foods that will promote health and cut out the junk.

At the very least, we can all agree that no one should be living on drive-through fast-food, soda or candy. Start looking at food as more than just "belly filler." See food as your disease prevention and treatment tools which will ensure a long and happy life.

I have identified seven basic food habits that will help you maintain a healthy eating lifestyle. These have been shared with my clients for years.

Usually at the end of our discussion, all my clients come to an "ah-ha" moment and realize they are actually quite simple. "They make so much sense!"

I hope you will agree.

1. Keep hydrated, always: Drink a variety of liquids, 90% of them must be close to 0 calories. Be aware that when you are thirsty, you can confuse this for hunger. When your body doesn't have enough water it leads to poor digestion, headaches, and fatigue. Carry a refillable water bottle with you always.

2. Plan. Avoid becoming comfortable with a lifestyle that allows you to do food on the fly or on the run. Have a plan and get used to it. When we plan our meals, we can better balance our intake. Shoot for at least 70% of your weekly meals to be planned. Then leave room for spur-of-the-moment meals.

3. Eat veggies with every meal. 100% of your meals should have veggies. Yes, get creative and find ways to incorporate vegetables in every single meal of your day, including breakfast and snacks. Goal: 9-13 servings per day. You can do it.

4. Snack on foods that matter. Include fruits, veggies and nuts. Don't snack on junk food. It actively deteriorates your health. There is no minimal allowance for that, so just eliminate it.

5. Think of common snacks such as chips, pizza, brownies, and cookies as "once in a while treats." Don't look at them as foods that fulfill your physical needs. It's okay to have them, but understand they are special treats. You still need nutritional fill from other foods. When you do indulge in them, choose wisely. Go for bean chips, brownies that include black beans, or cookies made with oats and nuts.

6. Say goodbye to the top culprits of bad health habits such as sodas and candy bars. Limit alcohol and say "NO" to all artificial preservatives and food coloring. Avoid all products made with high fructose corn syrup and excessive sugar of any kind including raw sugar, beet sugar and artificial sweeteners.

7. Take the time to eat. No more eating in a hurry. Sit and eat, chew your food. Allow the flavors to permeate you mouth. Enjoy what you are eating and give your saliva time to begin the digestive process.

Gradually adopt these eating habits, or go for all seven of them at once. The first three are my top picks for you.

I'll finish up with a very popular quote in the world of nutrition from the author of Food Rules: An Eater's Manual, Michael Pollan: "Eat food. Not too much. Mostly plants."

Carolina Jantac, MS, RD, LD, Co-Host: Family Food Kitchen (RadioMD)

Carolina Lima Jantac, MS, RD, LD, Nutrition Expert, and Social Media Manager is excited to be a part of an important program for mothers, dads, and kids who need so much guidance. As a Registered Dietitian, she has spent most of her career working in pediatric and adult hospitals as well as long term care centers.

She has learned and applied the power of food and choices we make regarding nutrition as the number one impact on health, longevity and quality of life. Her research at University of Florida on Vitamin B6 was published in the Journal of Nutrition and Metabolism (2007). Carolina brings international flare as she has a dual citizenship (Brazilian and US). She is a brilliant cook.

"I am happily married and have been blessed with two healthy children, Isabela and Daniel. They are great kids and my personal 'experiment' as I introduce them to new foods and educate them on healthy eating, raising them to be good examples of good nutritional choices making a difference for life!"

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There are so many "healthy" eating diets, trends, tricks and new food miracles hyped in the media that it can be quite stressful to follow. Some of them encourage complete opposite food groups, like fat and sugar.

# data[].attributes.attachment_link.readable_text
Find healthy choices for snacks and plan ahead:

If you are in the habit of eating candy at the end of the day for energy, try having a cup (240 milliliters) of herbal tea and a small handful of almonds. Or take a quick walk when you are feeling an energy low.

Eat fruit and yogurt in the mid-afternoon about 3 or 4 hours after lunch.

Control your portion sizes. It is hard to eat only a few chips or other tempting foods when there is a lot in front of you. Take only a small portion and put the rest away. Eat on a plate or in a bowl instead of straight out of a bag.

Eat slowly:

Put down your fork between bites.

Wait until you have swallowed your mouthful of food before taking the next bite.

Eating too quickly leads to overeating when the food you have eaten has not yet reached your stomach and told your brain you are full. You will know you are eating too quickly if you feel stuffed about 20 minutes after you stop eating.

Eat only when you are hungry:

Eating when you feel worried, tense, or bored also leads to overeating. Instead, call a friend or go for a walk to help you feel better.

Give your body and your brain time to relax from the stress of daily life. Take a mental or physical break to help you feel better without turning to food as a reward.

Make healthier, nutrient-rich choices:

Replace your candy dish with a bowl of fruit or nuts.

When you do have unhealthy foods in your house, put them in a place that is hard for you to reach rather than out on the counter.

Plan your meals:

Know what you will eat ahead of time so you can avoid buying unhealthy foods (impulse buying) or eating at fast-food restaurants.

Plan your dinners at the beginning of the week so you can prepare healthy, well-balanced meals each evening.

Prepare some dinner components ahead of time (such as chopping vegetables). This will allow you to put together a healthy meal more quickly at the end of the day.

Breakfast sets the tone for the day. A hearty, healthy breakfast will give your body the energy it needs to get you to lunch. If you are not hungry when you wake up, you could try a glass of milk or a small fruit and dairy-based smoothie.

Plan a good lunch that will satisfy you, and a healthy afternoon snack that will keep you from becoming too hungry before dinner time.

Avoid skipping meals. Missing a regular meal or snack often leads to overeating or making unhealthy choices later.

Once you have changed 1 or 2 old unhealthy habits, try changing 1 or 2 more.

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Eating habits and behaviors: MedlinePlus Medical Encyclopedia

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Food gives our bodies the energy we need to function. Food is also a part of traditions and culture. This can mean that eating has an emotional component as well. For many people, changing eating habits

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https://blog.oup.com/2012/01/sciwhys-why-do-we-eat-food/

# data[].attributes.body
What are food habits.

# data[].attributes.attachment_link.description
Margaret Mead, The Factor of Food Habits, The Annals of the American Academy of Political and Social Science, Vol. 225, Nutrition and Food Supply: The War and After (Jan., 1943), pp. 136-141

# data[].attributes.attachment_link.readable_text
Find healthy choices for snacks and plan ahead:

If you are in the habit of eating candy at the end of the day for energy, try having a cup (240 milliliters) of herbal tea and a small handful of almonds. Or take a quick walk when you are feeling an energy low.

Eat fruit and yogurt in the mid-afternoon about 3 or 4 hours after lunch.

Control your portion sizes. It is hard to eat only a few chips or other tempting foods when there is a lot in front of you. Take only a small portion and put the rest away. Eat on a plate or in a bowl instead of straight out of a bag.

Eat slowly:

Put down your fork between bites.

Wait until you have swallowed your mouthful of food before taking the next bite.

Eating too quickly leads to overeating when the food you have eaten has not yet reached your stomach and told your brain you are full. You will know you are eating too quickly if you feel stuffed about 20 minutes after you stop eating.

Eat only when you are hungry:

Eating when you feel worried, tense, or bored also leads to overeating. Instead, call a friend or go for a walk to help you feel better.

Give your body and your brain time to relax from the stress of daily life. Take a mental or physical break to help you feel better without turning to food as a reward.

Make healthier, nutrient-rich choices:

Replace your candy dish with a bowl of fruit or nuts.

When you do have unhealthy foods in your house, put them in a place that is hard for you to reach rather than out on the counter.

Plan your meals:

Know what you will eat ahead of time so you can avoid buying unhealthy foods (impulse buying) or eating at fast-food restaurants.

Plan your dinners at the beginning of the week so you can prepare healthy, well-balanced meals each evening.

Prepare some dinner components ahead of time (such as chopping vegetables). This will allow you to put together a healthy meal more quickly at the end of the day.

Breakfast sets the tone for the day. A hearty, healthy breakfast will give your body the energy it needs to get you to lunch. If you are not hungry when you wake up, you could try a glass of milk or a small fruit and dairy-based smoothie.

Plan a good lunch that will satisfy you, and a healthy afternoon snack that will keep you from becoming too hungry before dinner time.

Avoid skipping meals. Missing a regular meal or snack often leads to overeating or making unhealthy choices later.

Once you have changed 1 or 2 old unhealthy habits, try changing 1 or 2 more.

# data[].attributes.attachment_link.title
Eating habits and behaviors: MedlinePlus Medical Encyclopedia

# data[].attributes.attachment_link.description
Food gives our bodies the energy we need to function. Food is also a part of traditions and culture. This can mean that eating has an emotional component as well. For many people, changing eating habits

# data[].attributes.body
What factors influence a persons diet?

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There many factors that influence your diet. In this article, we are going to focus on the impact social and cultural factors have on healthy eating. To fully understand the concept, let's look at the basic nature of the human social environment.

According to social scientists Elizabeth Barnett, Ph.D. and Michele Casper, Ph.D.:

"Human social environments encompass the immediate physical surroundings, social relationships, and cultural milieus within which defined groups of people function and interact. Components of the social environment include built infrastructure; industrial and occupational structure; labor markets; social and economic processes; wealth; social, human, and health services; power relations; government; race relations; social inequality; cultural practices; the arts; religious institutions and practices; and beliefs about place and community. [ ... ] Social environments can be experienced at multiple scales, often simultaneously, including households, kin networks, neighborhoods, towns and cities, and regions."

Forming Dietary Habits, The Beginning

Dietary habits and choices develop early. An infant's eating habits are shaped by their parents in accordance with their view of what constitutes a healthy baby. Those views are shaped by society and can indirectly affect the nutrition the baby receives. Parents who follow a vegan diet, for example, are more likely to introduce vegan food to their children. Some people perceive a heavy baby as more healthy and feed accordingly to achieve such an outcome. Food can be used as a reward for good behavior; sometimes food is used to interrupt bad behavior.

Some research suggests that children pick up eating behaviors by observing the eating habits of others. Frankly, that sounds like the sort of common sense that didn't need to be clarified with research. After all, children learn nearly everything by copying the behavior of others. As such, it's important for parents to be a good role model and be careful with the way they encourage or discourage certain types of food. Parents who adopt a "do as I say, not as I do" philosophy or prohibit certain types of food may find themselves having to deal with unexpected consequences when a food's "forbidden" status makes it more desirable.

Conversely, trying to force a child to eat a specific healthy food isn't a solid strategy either. Studies show that forcing kids to eat fruits and vegetables they do not like may discourage good eating habits.

When parents are selecting food for their kids, variety and options are key. Parents have the job of choosing what kids eat and shaping their eating habits. This has a big impact on their health, perhaps a bigger impact than anything else. "Children learn about foods they like or dislike by being exposed to different types of food and observing and experiencing the consequences and rewards of consuming those foods."

How Society Influences Diet

Culture and society are essential in shaping a person's diet. Unfortunately, as a society where cheap is good and fast is better, we've welcomed super-sized, low-cost fast food that has paved the way for a massive increase in the rate of obesity. In fact, the increased consumption of high calorie, low-nutrition food has spawned an obesity epidemic.

According to the Journal of American Medicine, more than one-third (34.9%) of U.S. adults are obese. Approximately 17% (or 12.7 million) of children and adolescents aged two to nineteen years are obese.

There is also a strong, inverse association between socioeconomic factors such as occupation, income, and obesity. A study documented that the cost of healthy food such as fruits and vegetables is higher than less nutritious, energy-dense food.

Food has become our new national pastime and most social events are centered around food. For example, more than 20 million hot dogs are sold at Major League Baseball games every season. Over 60% of people who go to games say they cannot live without hot dogs during the game.

Perhaps no "food" has a bigger impact on society than alcohol. It has the potential to be the one consumable item that can be a common thread in social gatherings. While consuming alcohol in moderation may not have a major impact on your health, alcohol abuse can be very detrimental to your health.

Friends and family exert an influence over your eating habits. When people are together, they tend to eat more, or less, than when they're alone (depending how much others eat). The type of food eaten in social situations can be different than the food eaten when a person is alone. One study, in particular, found, "Meals eaten with others contained more carbohydrate, fat, protein, and total calories." Makes sense. After all, an appetizer is fun to share.

How Culture Influences Diet

Media and technology have been a shaping force in culture for many years. This isn't always for the better. Unfortunately, within the realm of eating habits, research shows that children who watch television are more likely to have unhealthy eating habits.

In our culture, eating trends are also pushed by marketing strategies that may or may not be for the betterment of society. Certainly, the advertisements for highly processed, highly refined, unhealthy food full of artificial sweeteners, fat, and salt aren't a positive influence. Adding a "cool" and "fun" theme is simply masking these strategies, and it's offensive. Especially considering the effect a child's eating habits will have on their health throughout their entire life. Too often, people start out on the wrong foot and end up on track to eating and drinking themselves to death.

Many people, especially young adults, are susceptible to how the media portrays the "perfect body." Is the media to blame for the epidemic of body dysmorphia and other self-image issues? Magazines full of slim girls or muscular men may lead to a negative body image and, in turn, encourage unhealthy habits. When this is coupled with other factors, such as mental health, there's little question why serious, sometimes life-threatening, body image and eating disorders are so common.

Anorexia nervosa, bulimia nervosa, binge eating disorder, and their variants, are serious disturbances in eating behavior. They are associated with a wide range of negative psychological, physical, and social consequences. Eating disorders may start small but obsessive behavior escalates quickly and it doesn't take long for a serious problem to emerge. Eating disorders are real, treatable medical illnesses.

Anorexia

When people have anorexia nervosa, they see themselves as overweight, even when they are clearly underweight. Eating, food, and weight control become obsessions. There are many symptoms of anorexia, but the most common include weighing oneself repeatedly, eating very small quantities of food, self-induced vomiting, misusing laxatives, diuretics, or even enemas. Anorexia is actually associated with the highest mortality rate of any psychiatric disorder!

Bulimia

People with bulimia nervosa tend to eat unusually large amounts of food and feel a lack of control over these episodes. Binge-eating is followed by the use of laxatives, diuretics, fasting, excessive exercise or any combination of them. The goal is to compensate the out-of-control eating.

People with this disorder often maintain a normal weight. But the psychological fear factors remain the same-the fear of gaining weight and intense unhappiness with body size and shape. Bulimic behavior is often done secretly as it is often accompanied by feelings of disgust or shame.

Binge-Eating Behavior

Binge-eating behavior often leads to losing control over eating. The difference between binge-eating and bulimia is that in both cases, people eat excessive amounts of food, but people with bulimia compensate out-of-control eating with purging, while pure binge-eaters will not. As a result, people with binge-eating disorder often become overweight or obese.

Inculcating Good Eating Habits

Parents play an important role in shaping the eating habits of their children. If you are a parent, there are a few things to keep in mind.

Expose your kids to a range of healthy foods and start when they're young. Cheap, poor-quality foods of convenience aren't appropriate for anyone of any age. Provide gentle guidance but be careful when it comes to strictly forbidding food. If you're purchasing the groceries, most of the control will be in your hands by default. However, as kids get older and spend more time with friends and away from their parents, they will make their own decisions. It's important to teach them honestly as opposed to dictating forcefully. Developing a solid foundation of healthy eating habits at home will go a long way.

An easy way to maintain perspective is to ask yourself why people eat? Ultimately, the reason is (or should be) to provide life-giving nourishment to our bodies. Basing your food choices on the nourishment your body needs instead of the junk food that looks tasty is one strategy for making better choices.

Of course, it is not always easy to maintain a healthy diet. For example, many people don't have the time or desire to cook at home. For others, natural or organic ingredients may be less available. It can also be difficult to consistently follow a balanced diet. When you consider all the macro and micronutrients your body needs on a daily basis, it's not difficult to understand why many people may not receive the complete nutrition they need. In those instances, vitamins and natural supplements can be a great way to fill the gaps between your nutritional requirements and your nutritional intake.

Can you think of a way society has influenced the way you eat? Have you overcome any trends you weren't even aware you were following? Leave a message below and share your thoughts.

References (20)

1. Elizabeth Barnett, Ph.D. and Michele Casper, Ph.D. A Definition of "Social Environment". National Institutes of Health; 2000. FRAES-00-004.

2. Dr. Leann Birch, Jennifer S. Savage, Alison Ventura. Influences on the Development of Children's Eating Behaviours: From Infancy to Adolescence. Can J Diet Pract Res. 2007; 68(1): s1-s56.

3. Baughcum AE, Burklow KA, Deeks CM, Powers SW, Whitaker RC. Maternal feeding practices and childhood obesity: a focus group of low-income mothers. Archives of Pediatric & Adolescent Medicine.

4. Young EM, Fors SW, Hayes DM. Associations between perceived parent behaviors and middle school student fruit and vegetable consumption. Journal of Nutrition Education and Behavior 2004 Jan-Feb;36(1):2-8.

5. Fisher JO, Mitchell DC, Smiciklas-Wright H, Birch LL. Parental influences of young girls' fruit and vegetable, micronutrient and fat intakes. Journal of American Dietetic Association, 2002 Jan; 102(1):58-64.

6. Fisher JO, Birch LL. Restricting access to palatable foods affects children's behavioral response, food selection, and intake. The American Journal of Clinical Nutrition 1999 Jun;69(6):1264-72.

7. Faith MS, Scanlon KS, Birch LL, Francis LA, Sherry B. Parent-child feeding strategies and their relationships to child eating and weight status. Obesity Research. 2004 Nov;12(11):1711-22.

8. Fisher JO, Mitchell DC, Smiciklas-Wright H, Birch LL. Parental influences on young girls' fruit and vegetable, micronutrient and fat intakes. The American Journal of American Dietetic Association. 2002 Jan;102(1):58-64.

9. Jennifer L. Harris, John A. Bargh. The Relationship between Television Viewing and Unhealthy Eating: Implications for Children and Media Interventions. Health Commun. 2009 Oct; 24(7): 660-673.

10. French SA, Story M, Neumark-Sztainer D, Fulkerson JA, Hannan P. Fast food restaurant use among adolescents: associations with nutrient intake, food choices and behavioral and psychosocial variable. International Journal of Obesity Related Metabolism Disorders. 2001 Dec;25(12):1823-33.

11. Jeffery RW, Utter J. The changing environment and population obesity in the United States. Obesity Research. 2003 Oct;11 Suppl:12S-22S.

12. Ball K, Crawford D. Socioeconomic status and weight change in adults: a review. Social Science and Medicine. 2005 May;60(9):1987-2010. Epub 2004 Nov.

13. Drewnowski A, Darmon N. Food choices and diet costs: an economic analysis. The Journal of Nutrition 2005 Apr;135(4):900-4.

14. "The Economy of Food at Sporting Events." Sports Management Degrees. N.p., n.d. Web. 26 July 2016.

15. Herman CP, Roth DA, Polivy J. Effects of the presence of others on food intake: a normative interpretation. Psychological Bulletin. 2003 Nov;129(6):873-86.

16. de Castro JM, de Castro ES. Spontaneous meal patterns of humans: influence of the presence of other people. The American Journal of Clinical Nutrition. 1989 Aug;50(2):237-47.

17. Jennifer L. Harris, John A. Bargh. The Relationship between Television Viewing and Unhealthy Eating: Implications for Children and Media Interventions. Health Commun. 2009 Oct; 24(7): 660-673.

18. Marge Dwyer. New strategies needed for preventing eating disorders. Harvard School of Public Health.

19. Wendy Spettigue, Katherine A. Henderson. Eating Disorders and the Role of the Media. Canadian Academy of Child and Adolescent Psychiatry.

20. Eating Disorders: About More than Food. National Institute of Mental Health.

†Results may vary. Information and statements made are for education purposes and are not intended to replace the advice of your doctor. Global Healing Center does not dispense medical advice, prescribe, or diagnose illness. The views and nutritional advice expressed by Global Healing Center are not intended to be a substitute for conventional medical service. If you have a severe medical condition or health concern, see your physician.

This entry was posted in Children's Health, Foods, Foods to Avoid, Health, Nutrition

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Dr. Edward Group DC, NP, DACBN, DCBCN, DABFM

# data[].attributes.attachment_link.title
How Culture and Society Influence Healthy Eating

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There many factors that influence your diet. In this article, we are going to focus on the impact social and cultural factors have on healthy eating. To fully understand the concept, let's look at the basic nature of the human social environment. According to social scientists Elizabeth Barnett, Ph.D.

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food habits happen in the home and within the family.

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How and when are food habits established?
Some things that you can do to develop good eating habits are having a set schedule and also having a variety of food presented to your children.

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When it comes to establishing healthy eating habits, both the parent and the child have resonsibilities.

Parent's Responsibility

Providing a variety of foods from which your child can choose

Parents provide appropriate food selections for meals and snacks to meet their children's needs for growth and development.

Developing a schedule of meal and snack times for your child

Children need to eat meals and snacks. Because their stomachs are so small, children need to have five to six small frequent meals, or three meals a day with two or three snacks between meals. Having evenly spaced planned meals and snacks helps you avoid questions like, "When are we eating?" and "I'm hungry, when are we having dinner?"

Providing an appropriate mealtime environment

Children should focus on food during meal and snack times. Eating at the table prevents the child from confusing eating with playtime. Distractions, like watching television or playing games at the table, should be avoided.

Child's Responsibility

Deciding what to eat of the foods offered

Only your child knows if he or she is hungry. If it is mealtime and your child chooses not to eat, don't try to make him or her eat. Don't only cook the foods that your child likes or make a substitute meal if he or she chooses not to eat the meal that you have prepared.

Deciding how much to eat of the foods offered

You should not make your child eat. Your child knows how much he or she needs to eat. Allow your child's hunger to regulate the amount of food he or she eats.

Pickiness or refusal to eat often results from inappropriate tactics such as force feeding, bribing and punishing. If parents eat a variety of healthy foods, the child will be more likely to try and like a variety of foods.

Studies show that children generally will grow up to eat the way that their parents eat. Predictable meal and snack times, a pleasant atmosphere and a wholesome balanced diet will provide your child with a foundation of good eating habits for her future. In addition, planning ahead will ensure that you and your child will have tasty food that is good for both of you.

What Not to Worry About

Wariness about new foods

Though it may take time, your child will learn to like a variety of foods. Children will repeatedly examine foods that they are offered, with or without trying the food items. Eventually, the child may try the food by putting it in his or her mouth and then taking it out again. These actions are normal. Avoid punishing or scolding a child for these behaviors. A child may be offered a food 10 to 15 times before swallowing it and then may only eat it occasionally.

Eating habits that change daily

Children will often eat a lot of food one day and not so much the next day. The foods the child likes also can change not only from day to day, but also from meal to meal. Some days, your child may eat a lot in the morning and not much else for the rest of the day. These habits are usually normal. It is important for parents not to focus on these fluctuations.

Appetite and appetite changes

Children know how much they need to eat and are sensitive to their appetites and appetite changes. Children also grow differently and have individual needs and eating habits. Children often eat the majority of their food early in the day. Dinner may be their smallest meal. In addition, children have different levels of activity on a day-to-day basis. Activity can affect the amount of food the child may eat on that day. It's important to keep in mind that children know when they're hungry and when they're not.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.

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When it comes to establishing healthy eating habits, both the parent and the child have resonsibilities. Providing a variety of foods from which your child can choose Parents provide appropriate food selections for meals and snacks to meet their children's needs for growth and development.

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Different countries have different eating habits.

https://www.health.com/food/10-healthy-eating-habits-from-around-the-world

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Food habits are established at home. It depends on what is in your pantry. Parents need to establish rules about healthy and unhealthy foods.

# data[].attributes.attachment_link.readable_text
When it comes to establishing healthy eating habits, both the parent and the child have resonsibilities.

Parent's Responsibility

Providing a variety of foods from which your child can choose

Parents provide appropriate food selections for meals and snacks to meet their children's needs for growth and development.

Developing a schedule of meal and snack times for your child

Children need to eat meals and snacks. Because their stomachs are so small, children need to have five to six small frequent meals, or three meals a day with two or three snacks between meals. Having evenly spaced planned meals and snacks helps you avoid questions like, "When are we eating?" and "I'm hungry, when are we having dinner?"

Providing an appropriate mealtime environment

Children should focus on food during meal and snack times. Eating at the table prevents the child from confusing eating with playtime. Distractions, like watching television or playing games at the table, should be avoided.

Child's Responsibility

Deciding what to eat of the foods offered

Only your child knows if he or she is hungry. If it is mealtime and your child chooses not to eat, don't try to make him or her eat. Don't only cook the foods that your child likes or make a substitute meal if he or she chooses not to eat the meal that you have prepared.

Deciding how much to eat of the foods offered

You should not make your child eat. Your child knows how much he or she needs to eat. Allow your child's hunger to regulate the amount of food he or she eats.

Pickiness or refusal to eat often results from inappropriate tactics such as force feeding, bribing and punishing. If parents eat a variety of healthy foods, the child will be more likely to try and like a variety of foods.

Studies show that children generally will grow up to eat the way that their parents eat. Predictable meal and snack times, a pleasant atmosphere and a wholesome balanced diet will provide your child with a foundation of good eating habits for her future. In addition, planning ahead will ensure that you and your child will have tasty food that is good for both of you.

What Not to Worry About

Wariness about new foods

Though it may take time, your child will learn to like a variety of foods. Children will repeatedly examine foods that they are offered, with or without trying the food items. Eventually, the child may try the food by putting it in his or her mouth and then taking it out again. These actions are normal. Avoid punishing or scolding a child for these behaviors. A child may be offered a food 10 to 15 times before swallowing it and then may only eat it occasionally.

Eating habits that change daily

Children will often eat a lot of food one day and not so much the next day. The foods the child likes also can change not only from day to day, but also from meal to meal. Some days, your child may eat a lot in the morning and not much else for the rest of the day. These habits are usually normal. It is important for parents not to focus on these fluctuations.

Appetite and appetite changes

Children know how much they need to eat and are sensitive to their appetites and appetite changes. Children also grow differently and have individual needs and eating habits. Children often eat the majority of their food early in the day. Dinner may be their smallest meal. In addition, children have different levels of activity on a day-to-day basis. Activity can affect the amount of food the child may eat on that day. It's important to keep in mind that children know when they're hungry and when they're not.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.

# data[].attributes.attachment_link.description
When it comes to establishing healthy eating habits, both the parent and the child have resonsibilities. Providing a variety of foods from which your child can choose Parents provide appropriate food selections for meals and snacks to meet their children's needs for growth and development.

# data[].attributes.body
1. Food is also a part of traditions and culture. This can mean that eating has an emotional component as well. For many people, changing eating habits is very hard. You may have had certain eating habits for so long that you do not realize they are unhealthy.
link below
2.
3. Allergies and disease affect can affect what people can eat
Eating disorders - Symptoms and causes - Mayo Clinic

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Find healthy choices for snacks and plan ahead:

If you are in the habit of eating candy at the end of the day for energy, try having a cup (240 milliliters) of herbal tea and a small handful of almonds. Or take a quick walk when you are feeling an energy low.

Eat fruit and yogurt in the mid-afternoon about 3 or 4 hours after lunch.

Control your portion sizes. It is hard to eat only a few chips or other tempting foods when there is a lot in front of you. Take only a small portion and put the rest away. Eat on a plate or in a bowl instead of straight out of a bag.

Eat slowly:

Put down your fork between bites.

Wait until you have swallowed your mouthful of food before taking the next bite.

Eating too quickly leads to overeating when the food you have eaten has not yet reached your stomach and told your brain you are full. You will know you are eating too quickly if you feel stuffed about 20 minutes after you stop eating.

Eat only when you are hungry:

Eating when you feel worried, tense, or bored also leads to overeating. Instead, call a friend or go for a walk to help you feel better.

Give your body and your brain time to relax from the stress of daily life. Take a mental or physical break to help you feel better without turning to food as a reward.

Make healthier, nutrient-rich choices:

Replace your candy dish with a bowl of fruit or nuts.

When you do have unhealthy foods in your house, put them in a place that is hard for you to reach rather than out on the counter.

Plan your meals:

Know what you will eat ahead of time so you can avoid buying unhealthy foods (impulse buying) or eating at fast-food restaurants.

Plan your dinners at the beginning of the week so you can prepare healthy, well-balanced meals each evening.

Prepare some dinner components ahead of time (such as chopping vegetables). This will allow you to put together a healthy meal more quickly at the end of the day.

Breakfast sets the tone for the day. A hearty, healthy breakfast will give your body the energy it needs to get you to lunch. If you are not hungry when you wake up, you could try a glass of milk or a small fruit and dairy-based smoothie.

Plan a good lunch that will satisfy you, and a healthy afternoon snack that will keep you from becoming too hungry before dinner time.

Avoid skipping meals. Missing a regular meal or snack often leads to overeating or making unhealthy choices later.

Once you have changed 1 or 2 old unhealthy habits, try changing 1 or 2 more.

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Eating habits and behaviors: MedlinePlus Medical Encyclopedia

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Food gives our bodies the energy we need to function. Food is also a part of traditions and culture. This can mean that eating has an emotional component as well. For many people, changing eating habits

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What are food habits?
Food habits can be determined from self choice of foods, or cultural foods.
https://medlineplus.gov/ency/patientinstructions/000349.htm

How and when are habits established?
10% of America's children start to develop food habits in the ages of 2-5. Eating things such as fast food cause those habits to develop. https://www.parents.com/blogs/parents-news-now/2011/10/04/must-read/study-poor-eating-habits-develop-early-in-babies-toddlers/

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Body Size, early diets, start young

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Norwegian version of this page

The foundation of good health is laid early in life. Two studies show that dietary habits and body size in Norwegian children remain stable for the first seven years of life.

Body size and diet largely remain stable for Norwegian children in the first seven years of life. This is the conclusion of two studies that have examined the significance of stability in dietary habits, and stability in body size in the childhood years.

Heredity and environment

"Genes can have a considerable influence on the development of overweight and obesity in childhood, but the impact of the environment surrounding children is also of major importance," reports Anne Lene Kristiansen, a postdoctoral fellow at the University of Oslo's Department of Nutrition.

"Several systematic reviews have shown that overweight in parents is a key risk factor for overweight in the child. We also found this in our analyses. Overweight in the mother in particular is highly significant."

The results show that from the perspective of public health it is vital to promote a healthy diet at an early stage. This applies especially to the children of parents with a high body mass index.

Stable dietary habits in childhood years

Mona Bjelland has carried out research into children's eating habits. Getting Norwegian children to eat more fruit and vegetables poses major challenges in her opinion. Photo: Torunn H. Totland/privat.

Statistics derived from responses given in questionnaires answered by 9,025 mothers give a clear picture: there are few changes in the diet of Norwegian children during the first seven years of life.

Mona Bjelland is one of few researchers who have studied the stability of dietary habits in small children. She is also a postdoctoral fellow at the University of Oslo's Department of Nutrition.

"The children who eat little fruit and vegetables from as early as 18 months onwards also eat little fruit and vegetables at the age of seven. We observe a similar pattern when it comes to soft drinks and sugary fruit squash. The children who drink most at the 18-month stage are also those who drink most at the age of seven," says Bjelland.

The results are clearly linked to social differences. For example, the children of mothers with lower education eat fruit and vegetables more seldom and drink soft drinks and sugary fruit squash more often compared with the children of mothers with higher education.

"Nevertheless it is gratifying that the intake of soft drinks and sugary fruit squash appears to be low in childhood years," states Bjelland.

The greatest challenge regarding Norwegian children is to increase the children's consumption of fruit and vegetables.

Body size

Anne Lene Kristiansen has discovered that children who are born with a large body size also have a larger body size than their peers when they are seven years old. Photo: Gunnar F. Lothe/UiO.

It is not only the diet that remains stable for the first seven years of life. Anne Lene Kristiansen has examined stability in children's body size at birth and then at one, three and seven years of age respectively, and has concluded that this also remains stable.

The study presents Norwegian data on stability in children's body size for the first time. It also makes a significant contribution to research by including data from the time of birth, which we have had no satisfactory knowledge of previously.

"The findings are important because they confirm that Norwegian conditions are comparable to international conditions," Kristiansen maintains.

The results are also significant in the context of Bjelland's findings.

"We know that a diet with little fruit and vegetables combined with a daily intake of sugary drinks over time can increase the risk of developing overweight and obesity," says Bjelland.

"Therefore preventive and health-promoting interventions are vital."

Diet in the kindergarten

The two researchers are currently working together on a project that in their view may help to solve some of the main challenges presented by the diet of small children.

"Kindergartens have a great potential to become an important arena for promoting a healthy diet in small children so that healthy eating habits are established at an early stage," says Kristiansen.

"The kindergarten can also help to even out the social differences we see in the diet of small children today, since the large majority of children under school age attend a kindergarten," Bjelland adds.

The study is called BRA - med grønnsaker (GREAT - with vegetables) and will be carried out between 2015 and 2017 among kindergarten children in the county of Vestfold. The goal is to identify effective, evidence-based interventions that will increase the consumption of vegetables among children. These interventions will be accessible nationally to all counties, municipalities and kindergartens at the end of the study.

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Health habits are established early in life - Institute of Basic Medical Sciences

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Norwegian version of this page The foundation of good health is laid early in life. Two studies show that dietary habits and body size in Norwegian children remain stable for the first seven years of life. Body size and diet largely remain stable for Norwegian children in the first seven years of life.

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How does money affect your diet? This article explains how social economical status influences our food choices.