Perceptions about health, nutrition knowledge and MyPlate food categorization among US adolescents: A qualitative study

Authors: BARCO LEME, ANA - Universidade De Sao Paulo; FISBERG, REGINA - Universidade De Sao Paulo; BARANOWSKI, TOM - Children'S Nutrition Research Center (CNRC); NICKLAS, THERESA - Children'S Nutrition Research Center (CNRC); CALLENDER, CHISHINGA - Children'S Nutrition Research Center (CNRC); KASAM, ANNIE - Children'S Nutrition Research Center (CNRC); PHILIPPI, SONIA - Universidade De Sao Paulo; Thompson, Deborah - Debbe

Submitted to: Journal of Nutrition Education and Behavior
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/17/2020
Publication Date: 12/24/2020
Citation: Barco Leme, A.C., Fisberg, R.M., Baranowski, T., Nicklas, T., Callender, C.S., Kasam, A., Philippi, S.T., Thompson, D.J. 2020. Perceptions about health, nutrition knowledge and MyPlate food categorization among US adolescents: A qualitative study. Journal of Nutrition Education and Behavior. https://doi.org/10.1016/j.jneb.2020.11.008.
DOI: https://doi.org/10.1016/j.jneb.2020.11.008

Interpretive Summary: Dietary guidelines need to be clearly understood to be followed to thereby enhance health. Adolescents have been a common target of dietary guidelines due to their poor dietary practices. The words used to describe aspects of the diet, and the categories of foods that incorporate the guidelines, may be of concern for clarity to adolescents. This study asked adolescents to define terms commonly used in dietary guidelines and to categorize 20 of the foods most commonly consumed by adolescents using the most recent food categories. Adolescents defined "healthy" in terms of behaviors performed, e.g. diet, physical activity, but had difficulty defining other commonly used guideline terms, e.g. energy-dense, processed foods. Adolescents accurately classified 72% of the commonly consumed foods but had difficulty with complex foods e.g. pizza, chicken soup, which required the use of multiple categories, and foods that had both desirable and undesirable characteristics, e.g. potato chips and chocolate chip cookies. More research is needed on terms and categories used in dietary guidelines to enhance adolescent understanding, compliance and health.

Technical Abstract: Our objective was to understand how adolescents define related nutrition terms and use food groups to classify commonly consumed foods into the MyPlate food groups. A qualitative study with telephone interviews was conducted in the Houston metropolitan area in Texas. A convenience sample of 21 adolescents from a volunteer database of the research center participated in the study. Sociodemographic questions were asked before semi-quantitative structured interviews. The interview focused on understanding how adolescents defined health, other nutrition terms, and food groups, and how to use the MyPlate icon in categorizing commonly consumed foods into groups. Interviews were analyzed using a hybrid thematic approach with inductive and deductive analyses. Adolescents defined being healthy in terms of wellness-type behaviors (e.g. diet, physical activity, and sleep). They perceived clear differences between terms such as healthy vs unhealthy food but struggled to define others (e.g. energy-dense foods and processed foods). Mixed dishes, hard candies, chocolate chip cookies, and potato chips were the most difficult foods for the adolescents to classify into the MyPlate food groups, whereas apple, lettuce, and milk were easily classified. Food guidance systems, public health policies, and behavioral nutrition programs targeting adolescents might use health and nutrition terms and prescriptive food categories more clearly understood by adolescents.