Chapter 3 Everyone Has a Role in Supporting Healthy Eating PatternsPrint this section
The Social-Ecological Model
Consistent evidence shows that implementing multiple changes at various levels of the Social-Ecological Model is effective in improving eating and physical activity behaviors. For example, strong evidence from studies with varying designs and generally consistent findings demonstrates that school policies designed to enhance the school food setting leads to improvements in the purchasing behavior of children, resulting in higher dietary quality of the food consumed during the school day. For adults, moderate evidence indicates that worksite nutrition policies can improve dietary intake, and approaches targeting dietary intake and physical activity can favorably affect weight-related outcomes. These examples demonstrate how support and active engagement from various segments of society are needed to help individuals change their eating and physical activity behaviors and achieve positive outcomes. Approaches like these have the potential to improve population health if they can be incorporated into existing organizational structures and maintained over time. Among the components of the Social-Ecological Model, sectors and settings influence change at the population level and are addressed first in this discussion.
Figure 3-1. A Social-Ecological Model for Food and Physical Activity Decisions
The Social-Ecological Model can help health professionals understand how layers of influence intersect to shape a person's food and physical activity choices. The model below shows how various factors influence food and beverage intake, physical activity patterns, and ultimately health outcomes.
- Belief systems
- Body image
- Health care
- Public health
Businesses & Industries
- Planning and development
- Food and beverage
- Early care and education
- Recreational facilities
- Food service and retail establishments
- Other community settings
Data Sources: Adapted from: (1) Centers for Disease Control and Prevention. Division of Nutrition, Physical Activity, and Obesity. National Center for Chronic Disease Prevention and Health Promotion. Addressing Obesity Disparities: Social Ecological Model. Available at: http://www.cdc.gov/obesity/health_equity/addressingtheissue.html. Accessed October 19, 2015. (2) Institute of Medicine. Preventing Childhood Obesity: Health in the Balance, Washington (DC): The National Academies Press; 2005, page 85. (3) Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annu Rev Public Health 2008; 29:253-272.
Sectors include systems (e.g., governments, education, health care, and transportation), organizations (e.g., public health, community, and advocacy), and businesses and industries (e.g., planning and development, agriculture, food and beverage, retail, entertainment, marketing, and media). These sectors all have an important role in helping individuals make healthy choices because they either influence the degree to which people have access to healthy food and/or opportunities to be physically active, or they influence social norms and values. Positive influences on social norms and values can occur through effective health promotion and marketing strategies.
Professionals in these sectors have many opportunities to identify and develop strategies that help individuals align their choices with the Dietary Guidelines. Strategies could include supporting policy and/or program changes, fostering coalitions and networks, developing or modifying products and menus, and/or creating opportunities to be physically active. To ensure widespread adoption of these sectoral efforts, complementary efforts can include training, education, and/or motivational strategies.
Individuals make choices in a variety of settings, both at home and away from home. Away-from-home settings include early care and education programs (e.g., child care, preschool), schools, worksites, community centers, and food retail and food service establishments. These organizational settings determine what foods are offered and what opportunities for physical activity are provided. Strategies to align with the Dietary Guidelines that are implemented in these settings can influence individual choices and have the potential for broader population-level impact if they are integrated with strategies by multiple sectors. In combination, sectors and settings can influence social norms and values.
Opportunities To Align Food Products and Menus With the Dietary Guidelinesmore▼
During the past few decades, food products and menus have notably evolved in response to consumer demands and public health concerns. The food and beverage and food service sectors and settings have a unique opportunity to continue to evolve and better align with the Dietary Guidelines. Reformulation and menu and retail modification opportunities that align with the Dietary Guidelines include offering more vegetables, fruits, whole grains, low-fat and fat-free dairy, and a greater variety of protein foods that are nutrient dense, while also reducing sodium and added sugars, reducing saturated fats and replacing them with unsaturated fats, and reducing added refined starches. Portion sizes also can be adapted to help individuals make choices that align with the Dietary Guidelines. Food manufacturers are encouraged to consider the entire composition of the food, and not just individual nutrients or ingredients when developing or reformulating products. Similarly, when developing or modifying menus or retail settings, establishments can consider the range of offerings both within and across food groups and other dietary components to determine whether the healthy options offered reflect the proportions in healthy eating patterns. In taking these actions, care should be taken to assess any potential unintended consequences so that as changes are made to better align with the Dietary Guidelines, undesirable changes are not introduced.
Social and Cultural Norms and Values
Social and cultural norms are rules that govern thoughts, beliefs, and behaviors. They are shared assumptions of appropriate behaviors, based on the values of a society, and are reflected in everything from laws to personal expectations. With regard to nutrition and physical activity, examples of norms include preferences for certain types of foods, attitudes about acceptable ranges of body weight, and values placed on physical activity and health. Because norms and values are prevalent within a community or setting, changing them can be difficult. However, changes to sectors and settings—as previously discussed—can have a powerful effect on social and cultural norms and values over time and can align with the Dietary Guidelines.
Individual factors are those that are unique to the individual, such as age, sex, socioeconomic status, race/ethnicity, the presence of a disability, as well as other influences, such as physical health, knowledge and skills, and personal preferences. Education to improve individual food and physical activity choices can be delivered by a wide variety of nutrition and physical activity professionals working alone or in multidisciplinary teams. Resources based on systematic reviews of scientific evidence, such as the Dietary Guidelines and the Physical Activity Guidelines for Americans, provide the foundation for nutrition and public health professionals to develop programs and materials that can help individuals enhance their knowledge, attitudes, and motivation to make healthy choices.
All food and beverage choices are part of an individual’s eating pattern. Professionals can work with individuals in a variety of settings to adapt their choices to develop a healthy eating pattern tailored to accommodate physical health, cultural, ethnic, traditional, and personal preferences, as well as personal food budgets and other issues of accessibility. Eating patterns tailored to the individual are more likely to be motivating, accepted, and maintained over time, thereby having the potential to lead to meaningful shifts in dietary intake, and consequently, improved health.