This document discusses factors that influence food choices and healthy eating behaviors in Australia. It summarizes that: 1) Australians are not meeting the Australian Dietary Guidelines and there is a gap between prescribed healthy behaviors and actual behaviors. 2) Cost is an important factor but may not be the most influential, and other factors like food preferences, marketing strategies, time commitment and resources required also influence behaviors. 3) Understanding actual behaviors, rather than just prescribed behaviors, is important for effective health policy around obesity and diet. Policy needs to consider all the behavioral factors that influence food selection and how they vary with economic status.

1. Medicine, Nursing and Health Sciences
Melanie Voevodin, PhD Candidate Paul Komesaroff, Supervisor
melanie.voevodin@monash.edu paul.komesaroff@monash.edu
Monash Centre for the Study of Ethics in Medicine & Society (CEMS)
The Alfred Centre, Department of Medicine, Central Clinical School
Melbourne, Australia
02 August 2012
Is there life outside the
Australian Dietary Guidelines?

3. Declaration of Interest
1998 2003 2005 2012
Dietetics Policy & Gov Health Eco PhDStudy
Austin RMH AlfredReal Jobs RMIT Deakin Nestle
WCMICSARBIAS / YPINH Food LawOther Jobs

4. Attitudes Beliefs & Philosophy
…on the topic of evidence
 Fewer DBRCTs et al
 More case study, observational, market research
 Behaviour measures linked to intervention and outcome
Health economics puts the story in a
language decision-makers respond to
Policy analysis brings it all together to tell the story of
what is happening, why, and with what consequences
4

5. Attitudes Beliefs & Philosophy
…on the topic of empathy
 Difficult to have true empathy for something you haven’t
lived even with the best intentions
5

6. Melanie Voevodin & Paul Komesaroff
PhD Student 2010-2013 Supervisor
paul.komesaroff@monash.edumelanie.voevodin@monash.edu
MMeasuring DDietetic PPractice for OObesity
(MDP-O Study)
Can DietitiansDietitiansturn
the
around
ObesityObesityepidemic??
GPGP DietitianDietitian PatientPatient

7. Is there life outside the Australian
Dietary Guidelines (ADGs)?
YES
7

8. 8
The ADGs
Available scientific
evidence of what to
eat to achieve good
health.
Accepted benchmark
for policy.

9. 9
The Problem
Australia is ranked in the world’s ‘worst third’ for obesity
Almost in the world’s ‘worst third’ for fruit & veg intake
Australians are not choosing
the food science instructs them to
ADGs

10. 10
The Problem
Scientific Evidence
(prescribed behaviour)
Real Life
(actual behaviour)
Good Health Poor Health

11. 11
It is a problem because…
 An unwell population is less productive
 Pain and suffering (QOL)
 Resource use
One in two Australian adults
are BMI>25kg/m2
Treatment is prevention

12. 12
Obesity clusters in households
72% of households are a ‘family’
2.5 million Australians making food choices everyday
on behalf of others
Cost is an issue
$8pp/d = 40% of total weekly income
for welfare dependent family

13. Methodology
Policy Analysis
Finding solutions to complex problems
13
X
What is happening, why and with what consequences

14. Methodology Snapshot
14
+

15. The difference with ‘food’ as the problem
 Every person eats
 Individual is ‘gatekeeper’
 Making choices daily, every day
 Choice based on individual attitudes, beliefs, behaviours
 Everyone’s an expert (or can be)
15

16. 16
Cost relative to income is an issue
Kettings CM Voevodin M Sinclair AJ. A healthy diet consistent with Australian
health recommendations is too expensive for welfare-dependent families.
Australian and New Zealand Journal of Public Health 2009 33(6): 566-572
The cost of healthy food habits uses about
40% of the disposable income of welfare-
dependent families. Families earning an
average income would spend 20% for the
same food.
Healthy food habits are a fiscal challenge
to welfare-dependent families.

17. 17
Cost of Healthy Eating in Australia
54%
40% F&V
18%
10%
Eat Most
Bread and Cereal $30
Vegetables $56
Fruit $43
Eat Moderately
Lean meat, eggs, fish, chicken,
milk, yoghurt, cheese $44
Eat in small amounts
Oil, margarine, reduced fat spreads,
butter, sugar $22
Cost is to feed family of four for one week
Total $240; $60pp/week; $8pp/day

18. ‘see…cost is not the issue’
54%
40% F&V
18%
10%

19. Time and
effort is
cost ($)
54%
40% F&V
18%
10%
Voevodin M. The true cost of healthy eating. Nutridate 2012 23(1): 5-7

20. 54%
40% F&V
18%
10%
Voevodin M. The true cost of healthy eating. Nutridate 2012 23(1): 5-7
Time and effort is cost ($)

21. 54%
40% F&V
18%
10%
Voevodin M. The true cost of healthy eating. Nutridate 2012 23(1): 5-7
Time and effort is cost ($)

22. What are the ADGs asking us to do?
 No alcohol or non-alcoholic drinks
 Eat three meals a day, most at home
 Ignore the price drops and other strategies used to
promote and market unhealthy food
 Allow time to shop, transport, store, prepare, cook,
serve, eat home-prepared meals, and clean-up
 Have resources (money) for kitchen, storage, transport,
cooking, dining, and cleaning-up infrastructure

23. 23
The Problem
Scientific Evidence
(prescribed behaviour)
Real Life
(actual behaviour)
Good Health Poor Health

24. 24
Relative effort (effort relative to income)
What the ADGs want us to do What we actually do

25. 25
Relative effort (effort relative to income)
What the ADGs think we all have What we actually have

26. 26
The constant challenge to stick
Consumer

27. 27
Tomorrow I’ll get apples
..and after dinner we will
all go for a walk and work
off the Tim Tams
….and then I’ll never buy
Tim Tams again
The constant challenge to stick
Consumer
Tim Tams
2 packs $4

28. Each moment of choice….
28
kJ 300 300
Price $0.20 $0.45 – $0.90
Effort Easy Hard
Enjoyment 10 6
Spoilage risk Negligible Medium
Taste risk Negligible Medium
Income ($/week)
Consumereffort

29. 29
The information we
need to support
healthful behaviour
at
point of purchase
is the same
information food
companies use to
entice consumption.
Primary Carer
Tim Tams
2 packs $4

30. Key Points
 Australians do not meet the ADGs
 There is a gap between prescribed behaviour and actual
behaviour
 Cost is important, but may not be the most influential
 Investigating actual behaviour is an important next step
for policy

31. Key Points
Factors influencing behaviour:
1. Food preferences
2. Marketing strategies
3. Time commitment
4. Resources required
5. Cost of healthy food

32. 32
What does this all mean
for policy & practice?
Issue Consider..
Obesity is bad Business as usual is not an option
ADGs hard DBRCTs might not be best approach
Food choices Understanding behaviour (real life v prescribed)
Treatment Priority given to primary carer for services
And women of childbearing age

33. Key Points
Effective health policy requires an
understanding of how each of the
behavioural factors influence food
selection, and how these change with
economic status.

34. 34
A starting point for total cost
Preference
Willingness to spend on healthy food compared with
unhealthy;
Taste, familiarity, texture, risk, satisfaction and effect on
willingness to spend
Marketing
Frequency and type; effect of price elasticity on demand;
relative to unhealthy foods
Time
To cook, shop, prepare, clean up, transport; effort (relative
to income); opportunity cost
Resources
To cook, shop, prepare, clean up, transport; effort (relative
to income); opportunity cost
Cost
Actual cost; inflation; relative to income; relative to
unhealthy food; relative to actual spend