Implicit food associations as obstacles to healthy nutrition: the need for further research

Introduction

Diet-related diseases, such as type 2 diabetes mellitus and obesity, negatively affect quality of life, cause numerous deaths each year, and raise the health spending share of health insurance companies and national governments.^1-4 These negative impacts can be avoided to a large extent by a change in consumers’ lifestyles. Several international studies show that type 2 diabetes, for example, is largely preventable with early lifestyle change. ⁵ Key indicators for preventive success are the increase in physical activity and the modification of eating behaviour. Any contribution to fostering healthier food choices is relevant for the prevention of chronic diet-related diseases. ⁶ In particular, consumers need to increase the relative consumption of healthy, compared to unhealthy, food. Prevention methods are most efficient when they target high-risk groups at a preclinical stage of disease. They should focus on modifiable risk factors such as overweight and harmful lifestyle,^7,8 so that a change in consumers’ eating habits will have a major societal impact.

Extant prevention campaigns are helpful in raising problem awareness. Many consumers are now aware that healthy nutrition fosters their well-being. Despite the attitudinal change and the growing intention of many consumers to eat healthy food, efforts in changing actual nutritional behaviour have not yet led to satisfying results. It is our hypothesis that this discrepancy is due to the fact that nutrition behaviour is largely driven by implicit attitudes. Implicit attitudes are unconscious and automatic and cannot be verbalised. Although eating is an action of which the individual may be aware, control of eating habits is not necessarily explicit. In contrast, consumers frequently choose their food products in an unconscious manner. Empirical research demonstrates that consumers’ implicit and explicit attitudes towards healthy nutrition often diverge.^9-14 The distinction between implicit and explicit processes of food purchase, preparation and consumption therefore plays a key role in gaining a deeper understanding of the gap between positive explicit attitudes towards healthy nutrition and the consumption of non-healthy food.

To date, little is known about implicit drivers of unhealthy nutrition and how they can be overcome by prevention campaigns. The present paper outlines an agenda for intensifying research in this field. We argue that researchers can gain a holistic view of the complex process of food choice by combining the theories and methods of different fields. To guide future research, we suggest the following multiple-step approach: consumer segmentation, isolated analysis of different implicit drivers, holistic examination of interaction effects of different drivers and development of implications for policy makers and managers.

The proposed research agenda

Implicit attitudes towards unhealthy food stem from various sources, such as intrinsic product attributes (e.g. taste), extrinsic product attributes (e.g. branding), consumer lifestyle (e.g. convenience) and/or cognitive processing (e.g. visual perception). Since all of these factors influence food choice simultaneously, an explorative, holistic and multi-step approach is necessary to identify the implicit drivers of unhealthy eating habits (figure 1).

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Figure 1.

Overview of the research agenda

Discussion

Europe is faced with a fast growing prevalence of type 2 diabetes. This effect is driven by the increasing prevalence of obesity in Europe due to lifestyle and behavioural changes, by a continuously earlier onset of the disease in the younger population and by an increasing age of the European population. Interventions for the targeted or population-based primary and secondary prevention of diabetes may address this challenge. Studying consumer behaviour may become necessary for successfully implementing diabetes prevention programmes into daily practice. The suggested research agenda puts the focus on consumers’ implicit attitudes towards healthy and unhealthy food. Its overall academic prospect is to widen and deepen the understanding of implicit drivers of unhealthy nutrition. In this way, it contributes to the explanation of the attitude/intention–behaviour gap in food consumption. Theories can be developed on how attitudes towards unhealthy nutrition depend on the interaction of product-based and personal drivers. Furthermore, the agenda helps to establish a holistic framework to explain why different segments consume healthy or unhealthy food.

Based on these scientific outcomes, our agenda will provide producers, marketers, physicians and policy makers with new insights into why consumers refrain from buying healthy food. They will learn how to design effective communication campaigns. For product development, the findings will give hints about how to compensate the disadvantageous intrinsic attributes of healthy food (e.g. loss in taste) by improving extrinsic attributes (e.g. labelling, branding, packaging). In this way, our approach also contributes to the success of producers of healthy products (who must compete with producers of conventional food). The implications will help to design appropriate products that overcome fundamental obstacles for healthy nutrition. Note that our approach is focused on cognitive processes (both explicit and implicit). Food choice depends on additional factors, such as physiological processes of the human body, which might not be addressed by our approach. Future research should develop models of how to integrate these factors as well.

Fulfilling the agenda’s objectives will realistically increase the chances of implementing diabetes prevention programmes in European countries, which will lead to a more efficient reduction of type 2 diabetes, eventually bringing about social and economic benefits and positive impact on public healthcare costs.