Cultural influences on the regulation of energy intake and obesity: A qualitative study comparing food customs and attitudes to eating in adults from France and the United States

Authors: DAO, CARLOTA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; THIRON, SOPHIE - University Of Toulouse; MESSER, ELLEN - Tufts University; SERGEANT, CAMILLE - Public Assistance Hospital Of Paris; SEVIGNE, ANNE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; HUART, CAMILLE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; ROSSI, MELINDA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; SILVERMAN, ILYSSA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; SAKAIDA, KYLIE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; BEL LASSEN, PIERRE - Sorbonne Universities, Paris; SARRAT, CHARLOTTE - Danone Institute International; ARCINIEGAS, LAURA - University Of Toulouse; DAS, SAI KRUPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; GAUSSERES, NICOLAS - Danone Institute International; CLEMENT, KARINE - Sorbonne Universities, Paris; ROBERTS, SUSAN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Nutrients
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/23/2020
Publication Date: 12/28/2020
Citation: Dao, C.M., Thiron, S., Messer, E., Sergeant, C., Sevigne, A., Huart, C., Rossi, M., Silverman, I., Sakaida, K., Bel Lassen, P., Sarrat, C., Arciniegas, L., Das, S., Gausseres, N., Clement, K., Roberts, S. 2020. Cultural influences on the regulation of energy intake and obesity: A qualitative study comparing food customs and attitudes to eating in adults from France and the United States. Nutrients. https://doi.org/10.3390/nu13010063.
DOI: https://doi.org/10.3390/nu13010063

Interpretive Summary: The influence of food culture on eating behavior and risk of obesity is poorly understood. In this study, we organized interviews and focus groups with 25 adults in France with and without overweight to examine attitudes to food consumption and external pressures that influence eating behavior and weight status. Results were compared with a similar study conducted in the United States. The two countries were compared because they both have high rates of obesity and different food cultures and environments. In France, the most prominent topics mentioned by participants were: 1) Health, eating as a social activity, and pleasure as important factors in food choice; 2) General concern over food production methods and their impact on health and the environment; 3) Integration of healthy eating with health and wellbeing; and 4) Challenges around weight management, which were different depending on the participants' weight status. There were both similarities and differences compared to the U.S. data. Stress and difficulties in distinguishing hunger from cravings were obstacles to weight management in both countries. In addition, in the U.S. but not in France, overt external pressures to overeat were a major influence on food consumption, and there was strong discordance between the foods seen as healthy and foods considered tasty. This is the first qualitative comparison of food culture, eating behavior and weight management between these two countries. More research is needed to identify cultural influences on eating behavior that will lead to improved weight management strategies.

Technical Abstract: Background: The influence of food culture on eating behavior and obesity risk is poorly understood. (2) Methods: In this qualitative study, 25 adults in France with or without overweight/obesity participated in semi-structured interviews (n=10) or focus groups (n=15) to examine attitudes to food consumption and external pressures that influence eating behavior and weight management. Results were compared to an equivalent study conducted in the United States, thereby contrasting two countries with markedly different rates of obesity. Emerging key themes in the French data were identified through coding using a reflexive approach. (3) Results: The main themes identified were: 1) Influence of commensality, social interactions, and pleasure from eating on eating behavior, 2) Having a balanced and holistic approach to nutrition, 3) The role of environmental concerns in food consumption, 4) Relationship with "natural" products (idealized) and food processing (demonized), 5) Perceptions of weight status and management. Stress and difficulties in hunger cue discernment were viewed as important obstacles to weight management in both countries. External pressures were described as a major factor that explicitly influences food consumption in the US, while there was an implicit influence of external pressures through eating-related social interactions in France. In France, products considered "natural" where idealized and juxtaposed against processed and "industrial" products, whereas this was not a salient aspect in the U.S. (5) Conclusions: This first comparative qualitative study assessing aspects of food culture and eating behaviors across countries identifies both common and divergent attitudes to food and eating behavior. Further studies are needed to inform the development of effective behavioral interventions to address obesity in different populations.