Food Choice Decision-Making Among School-Going Adolescents Amidst the Nutrition Transition in Urban Accra, Ghana

Like many countries of the world, Ghana is experiencing a nutrition transition and rising non-communicable diseases. Adolescents are susceptible to diet-related health risks as they experience significant physical and psychological changes, which are happening in tandem with food environment changes, including widespread proliferation of large portion and package sizes of energy-dense, nutrient-poor foods. Both local and multinational food and beverage companies have encouraged consumption of their products through various marketing tactics targeted directly to adolescents. Some of these tactics include the use of characters or celebrity endorsement, promotional discounts, and appeal to sociocultural values, including messages about body size preferences. As a result, adolescents may experience conflicting messages from exposure to Western food marketing campaigns promoting abnormally thin bodies by consumption of foods that are known contributors to obesity and chronic diseases. This qualitative study used in-depth interviews to explore perspectives held by 48 public junior high males and female students in six urban districts of the Greater Accra Region of Ghana, with respect to healthy and unhealthy food, portion sizes, body image, and how advertising messages contribute to their food choice decision-making. The first aim sought to understand how adolescents conceptualize healthy and unhealthy foods, food portion sizes and purchasing behaviors. Students had rudimentary knowledge of nutrition, mostly derived from school curricula. However, their food choices were predominantly driven by attitudes and beliefs held by those in their social networks, cost considerations, and health claims on advertisements. Students did not fully understand what portion control and mindful eating was, though they recognized moderation as an important health behavior. The second aim sought to uncover perspectives by these same students regarding body image. Younger students and females felt more body image dissatisfaction and desire to change their current weight status. Body image aspirations were important in food choice decision-making; students alluded to people who they sought to emulate. Students discussed tensions with elders about types and quantities of food to eat and the body sizes that their elders wanted them to be versus what they wanted to look like. The results from this study suggest the need for social network and social marketing interventions that could address healthy eating habits, body dysphoria, as well as deceptive marketing tactics used to promote unhealthy foods for both adolescents and their caregivers

Elaborating the Science of Food Choice for Rapidly Changing Food Systems in Low-and Middle-Income Countries

The world’s food systems and environments have been changing dramatically, concomitant with changes in overand undernutrition. We elaborate the science of food choice to better understand, analyze, and respond to relationships between changing food environments and food choice. The science of food choice is concerned with generating knowledge about causal drivers of food choice decision making processes and behavior within immediate food and social environments. Three fundamental and interconnected questions undergird this science; 1) what do people eat from the options available and accessible?; 2) how do people interact with food environments?; and 3) why do people decide to acquire, prepare, distribute, and consume foods as they do? Not all food choice behavior is rational, reflexive, or discrete, but is embedded in wider activities of daily lives. The science of food choice involves understanding influences from multiple systems that drive food choice for deriving sound, actionable policy, and programmatic recommendations

Development of a methods repository for food choice behaviors and drivers at the household and individual levels

This brief identifies important constructs for assessing drivers of food choice behaviors and describes progress on the development of a repository of instruments and measures for assessing these constructs. OBJECTIVES 1. List constructs that can be assessed to understand drivers of household and individual food choice behaviors. 2. Identify instruments and measures to assess each food choice construct and organize these into a searchable repository. 3. Illustrate the use of the Food Choice Repository

Perspective: Food environment research priorities for Africa—Lessons from the Africa Food Environment Research Network

Over the last 2 decades, many African countries have undergone dietary and nutrition transitions fuelled by globalization, rapid urbanization, and development. These changes have altered African food environments and, subsequently, dietary behaviors, including food acquisition and consumption. Dietary patterns associated with the nutrition transition have contributed to Africa's complex burden of malnutrition—obesity and other diet-related noncommunicable diseases (DR-NCDs)—along with persistent food insecurity and undernutrition. Available evidence links unhealthy or obesogenic food environments (including those that market and offer energy-dense, nutrient-poor foods and beverages) with suboptimal diets and associated adverse health outcomes. Elsewhere, governments have responded with policies to improve food environments. However, in Africa, the necessary research and policy action have received insufficient attention. Contextual evidence to motivate, enable, and create supportive food environments in Africa for better population health is urgently needed. In November 2020, the Measurement, Evaluation, Accountability, and Leadership Support for Noncommunicable Diseases Prevention Project (MEALS4NCDs) convened the first Africa Food Environment Research Network Meeting (FERN2020). This 3-d virtual meeting brought researchers from around the world to deliberate on future directions and research priorities related to improving food environments and nutrition across the African continent. The stakeholders shared experiences, best practices, challenges, and opportunities for improving the healthfulness of food environments and related policies in low- and middle-income countries. In this article, we summarize the proceedings and research priorities identified in the meeting to advance the food environment research agenda in Africa, and thus contribute to the promotion of healthier food environments to prevent DR-NCDs, and other forms of malnutrition

Why understanding food choice is crucial to transform food systems for human and planetary health

What, how and why people eat has long been understood to be important for human health, but until recently, has not been recognised as an essential facet of climate change and its effects on planetary health. The global climate change and diet-related health crises occurring are connected to food systems, food environments and consumer food choices. Calls to transform food systems for human and planetary health highlight the importance of understanding individual food choice. Understanding what, how and why people eat the way they do is crucial to successful food systems transformations that achieve both human and planetary health goals. Little is known about how food choice relates to climate. To clarify potential paths for action, we propose that individual food choice relates to climate change through three key mechanisms. First, the sum of individual food choices influences the supply and demand of foods produced and sold in the marketplace. Second, individual food decisions affect type and quantity of food waste at the retail and household level. Third, individual food choices serve as a symbolic expression of concern for human and planetary health, which can individually and collectively stimulate social movements and behaviour change. To meet the dietary needs of the 2050 global population projection of 10 billion, food systems must transform. Understanding what, how and why people eat the way they do, as well as the mechanisms by which these choices affect climate change, is essential for designing actions conducive to the protection of both human and planetary health