Derrick is a thirty-five-year-old husband and father of two who returns from the doctor's office with a concerning topic to discuss with his family. His doctor let him know that he is at risk for developing heart disease and diabetes and that Derrick will need to make significant changes to his lifestyle if he wants to avoid those adverse health outcomes.
Derrick has already traveled down a pathway to poor health. His body mass index (BMI) is 31 kg/m2, and Derrick's doctor said he is "obese." The diagnosis of obesity came as a shock to Derrick. He knew that he had gained weight and was probably overweight but thought obesity was much more extensive. Derrick sat down with his family and explained to his children and wife that his doctor said he needs to make healthier food choices. Derrick's doctor was also concerned because of Derrick's family history. Derrick's mother and father were both diagnosed with coronary artery disease and diabetes. Derrick's wife, Elizabeth, started to feel somber as the news sank in. She was worried about her husband. Elizabeth was the type of person that never got sick, could eat anything she wanted, and still stay thin. But Elizabeth had been concerned when Derrick gained weight over the years. She thought her husband should exercise more, but that was about it. She went for the quick and easy meals her family enjoyed. They liked to eat out as a family: fast food on the weekends (or busy weeknights) was not uncommon.
Factors that Affect Dietary Change in Families
What are the factors that affect how successful families are at making changes to their diet?
Family food decisions are generally based on routine habits, and success happens when there are more positive experiences than negative ones. Many of the factors that determine success for individual change also apply to family change. However, family decision-making processes can be more complicated because of the additional variables that come into play.
For example, the way family members’ schedules interact influences family decision making. Due to the pandemic, more families are working and studying from home. Is the kitchen now being utilized as an office or study? Does the family eat together, or are their schedules so different that they can’t do this very often?
As individuals, we make many food decisions per day, such as eating a snack or not, and how much of the meal to consume. As Derrick’s doctor explained, the consequences of poor food choices can lead to chronic disease and/or gaining weight resulting in overweight and obesity.
Throughout the pandemic, many people have gained weight and become less active. There has also been increased depression and anxiety, which can lead to emotional eating, increased alcohol intake, and frequent snacking. People may also experience anxiety about food availability and may have purchased canned goods or non-perishable foods high in empty calories.
So how to get back on the right track to healthy eating?
Lasting dietary change can be difficult. The key to success is motivation and a well thought out plan that isn’t just a diet, but a healthy LIFESTYLE that includes a healthy dietary pattern. Here are some factors that contribute to whether a lasting change to a nutritious diet will take effect:
- Desire to change
- Planning ahead
- Money for the plan, and savvy shopping skills
- Food preparation, knowledge, and skills
- Taste and satisfaction of new foods, being creative in the kitchen, and knowing spices, herbs and good sauces that can make all the difference to acceptance
- Available time
- Kitchen space and equipment available
- Food storage space available
- Quality interactions during mealtimes
- Support of family members and friends
There are many reasons people want to change their dietary habits. A common motivation is a recent change in health. In our example, Derrick is motivated to change his diet because he wants to lower his risk of heart disease and diabetes. His wife is now also concerned about the kids and their future risk of disease. So, the family is in this together now.
But there is more to it than a desire to change. For a plan to be successful, it needs to fit into the family preferences, and at least one person in the household needs to know how to prepare the new foods. Making substitutions (not just avoiding a bunch of foods) and adding new foods can make this quite satisfying and sustainable. How about some new recipes?
How much time does it take to eat in this new way?
In addition to food preparation, there is the time to serve food and set the table, time to clean up afterward, and the time it takes storing and putting away food and drinks. Compared to eating fast-food, a home-cooked meal can require a lot more time and effort, especially for larger families. By and large, having more family members means more time spent on food preparation.
Additionally, there needs to be kitchen space and equipment available and storage space for ingredients and leftovers (that can make for great lunches the next day). Quality interactions surrounding mealtime is also essential as family dynamics become even more critical around times of change. In most families, decisions are made by two or more family members. The family leaders can influence others' food choice decisions, and supportive families that want to change are more successful than those who are resistant. However, even one family member can substantially influence other family members, especially when it is the father or mother that disapproves.
Factors that Affect Food Availability
What if healthy food is not available to purchase? In the United States, access to healthy foods
can be limited. Several factors that influence a family’s ability to regularly purchase healthy foods are:
- Location of grocery stores with affordable healthy food
- Location and number of fast-food restaurants
- Access to personal transportation
- Comfortability with shopping for, preparing and eating healthy foods
The type of food we eat can have a lot to do with where we live. Are there nearby quality grocery stores and local farmers' markets? The likeliness of buying healthy foods is determined by availability. Unhealthy food seems to be everywhere, and healthy foods can be hard to find.
Many people live near multiple fast-food chains, which can tempt individuals and families to eat unhealthy foods. Because of their convenience in location and reduced cost compared to more healthy options, fast food may be selected over a healthier alternative. However, these cheap foods can end up costing healthy lives down the road.
Another issue is access to personal transportation to purchase food from the grocery store. A personal vehicle is much more convenient for running to the grocery store than taking the bus or subway. Although grocery delivery options are now being offered, there are many limitations to buying food without selecting it personally. Even if there are good sources of food nearby, they may be too expensive. And high-quality grocery stores may be more common in racially segregated and affluent areas where minority and low-income community members may feel uncomfortable. The influence of the environment is enormous, and we, as a society, have a long way to go to equity.
Steps for Temporary Changes to Become New Routines
What are the steps in the process of implementing lasting change?
A study published in Annals of Behavioral Medicine in 2009 highlights the stages of making food choice changes in families. Steps toward making a change:
- Thinking About Food Choice Options
- Deciding to Change
- Selecting a Plan and Considering Options
- Attempting a Trial of New Food Choices
- Evaluation of Trial Run
- Repeat Changes and Temporarily Adopt Change
- Reconsider Changes and Select Alternatives
- Establish Healthy Eating Routines
We may have never consciously thought about the benefits and harms of changing our diet or what would go into making organized food goals. What was the family reaction to a family member's request to eat healthy foods? A possible response is, "I don't want to spend time cooking and preparing food," or, "I don't like healthy food."
If the goal is to change the diet to prevent or treat health concerns, we can look at it differently. We problem-solve the barriers; we don’t change the overall goal. For example, one way to reduce food preparation time is to try pre-made salad mixes and frozen vegetables. Saving time compared to buying fresh vegetables and chopping them up. Flavors can be added to any dish to resemble old favorites. Recognize that the family needs time to take on the change being considered. In some households, time is even more important than money when it comes to making dietary changes. All of these challenges can be achieved with creative thinking, persistence, and problem-solving.
It may help to get advice from a doctor, nutritionist, educational materials online, friends, family, and neighbors. Take a bit of time to be more deliberate in thinking about food options. Suppose the new plan is not viewed as an acceptable alternative to current eating. In that case, we should rethink and negotiate options and select another option instead of just reverting to the old way of eating. Once a trial run is attempted, it can be repeated, and a temporary pattern can be established. It's important to remember that consistent habits develop over time, and new routine practices of eating can be created.
Benefits of a Healthy Family Diet
One component of healthy food choices is deciding how much and how frequently to eat. We may overeat high-calorie and low nutritious foods and not enough of the fruits and vegetables that contain the vital components to a properly functioning immune system. The most apparent benefit of healthy eating is a healthy body, more energy, and decreased risk of chronic disease and cancers. Healthy eating can assist with fighting off viruses or quicker recovery times if we do get sick. Mealtimes also provide an opportunity to bring the family together. Teaching our children healthy habits can make a difference for the rest of the child's life and extend the quality of our own lives.
Cran-Apple Turkey Medallions (umassmed.edu)
Please check out the University of Massachusetts Medical School’s Center for Applied Nutrition website for information on healthy food options.
References
Ardyth M. H. Gillespie, Ph.D., Wendy L. Johnson-Askew, Ph.D., M.P.H., R.D., Changing Family Food and Eating Practices: The Family Food Decision-Making System, Annals of Behavioral Medicine, Volume 38, Issue suppl_1, December 2009, Pages s31–s36, https://doi-org.umassmed.idm.oclc.org/10.1007/s12160-009-9122-7
Bisogni CA, Jastran M, Shen L, Devine CM. A biographical study of food choice capacity: Standards, circumstances, and food management skills, J Nutr Educ Behav, 2005, vol. 37 6(pg. 284-291)
Bove CA, Sobal J. Foodwork in newly married couples: Making family meals, Food, Culture, and Society, 2006, vol. 9 1(pg. 70-89)
Jeffery Sobal, Ph.D., M.P.H., Carole A. Bisogni, Ph.D., Constructing Food Choice Decisions, Annals of Behavioral Medicine, Volume 38, Issue suppl_1, December 2009, Pages s37–s46, https://doi-org.umassmed.idm.oclc.org/10.1007/s12160-009-9124-5
Mancino L, Newman C. Who has time to cook? How family resources influence food preparation. Washington, DC: USDA, ERS; 2007. [July 5, 2012]. Who Has Time To Cook? How Family Resources Influence Food Preparation (usda.gov)
