NUTRITION INFORMATION USAGE IN FOOD CHOICES: A collection of interdisciplinary studies, with a focus on understanding the relation between intention and behavior

Healthy dietary intake patterns contribute to maintaining a good health and to theprevention of negative health consequences, such as hypertension. However, in spite ofthe negative effect of consuming unhealthy foods, which mostly are low-satiating,energy-dense, and have non-adequate quantities of micronutrients, consumers are stilloften engaging in food consumption behavior that negatively impacts their wellbeing.The usage of nutrition information, in this respect, can affect this food choice behavior.Next to reading this nutrition information, also the comprehension of this information isconsidered important in steering food choices, and thus dietary intake.According to multiple scientific sources, available nutrition information is often usedlimitedly, or incorrectly, in making food choices. Even consumers who have an activelong-term goal of consuming healthy foods, are found to not always utilize nutritioninformation to benefit their food choices. This group is characterized by having a strongmotivation to become or to stay healthy. As can be expected, however, there is a strongheterogeneity between these people in how well their intentions are translated intobehavior. In the second part of this thesis, we used a stage-model to describe howindividuals move through a pattern of distinct phases when translating intention tobehavior, derived from the Health Action Process Approach model. In doing so, westudied factors that influence how nutrition information affects food choices.In the first part of this thesis, we addressed two specific cases where foodconsumption decisions were steered by information about components of food. InChapter 2, we evaluated how European consumers perceive nutrition and health claimsabout specific food ingredients and what can be done to improve comprehension ofsuch claims. We found that nutrition and health claims are mostly only perceivedpositive by specific target consumers (who need the product, accept the ingredient,understand the benefit, and trust the brand). These consumers indicate that theproducts with substantiated and approved claims help them in reaching overall healthgoals, and are therefore willing to buy products with these claims. Other consumers,however, may have adverse reactions towards nutrition and health claims on functionalfoods. We set out that both from a legal perspective, as well as a public healthperspective, efforts should be made to increase nutrition literacy to avoidmisinterpretations of nutrition and health claims.In Chapter 3, a case study was presented in which nutrition information provided byvarious stakeholders is not in line with scientific findings. In particular, we evaluatedwhy recommendations to reduce fructose-consumption are disputable and impracticalgiven the current scientific findings on the relation between fructose and obesity. Weargued that the proposition that the causal role of fructose intake in the etiology of theglobal obesity epidemic rests on controversial interpretations of research. Whenconsumed in regular amounts, there appears to be no specific negative effect offructose-containing sugars on obesity – besides the expected contribution to the energybalance. Accordingly, consumers should not avoid foods with fructose-containingsugars. This chapter provided another example of how food choices are not determined solely by physiological needs (i.e., hunger or thirst), as they are dependent on manymore factors, including consumer perception of how a food may influence his or herhealth – termed outcome expectancies.In our overall conceptual model, we separated nutrition literacy as a distinctconstruct that influences how well intentions are converted into action, and added therole of demographic and psychosocial factors. In Chapter 4 of this dissertation, this rolewas further discussed using data obtained from a survey in individuals who intend toeat healthily. Using process tracing software in a computerized task in whichparticipants had to make dichotomous food choices, we measured the frequency andtime of categories of nutritional information considered. In the research, we confirmedthat, regardless of the increased aim to eat healthier, consumers often make choicesthat are not in line with their intention. The fundamental idea behind this phenomenonis the so-called intention-behavior gap. This phenomenon tells us that some people maydevelop an intention to perform healthy behavior, but they do not take the appropriateactions. We discussed that common psychosocial determinants of healthy behaviorneed to be augmented with a person’s actual reading and understanding of nutritioninformation to better explain the variance in healthy food choice behavior.In Chapter 5, we used the same date-set to form groups of consumers, who clusteron the level of energy, salt, sugar, and saturated fat levels considered. We did this toinvestigate differences between these groups and to see if consulting information onthese “four evils” leads to healthier choices. We confirmed the importance ofthoroughly reading available nutrition information to improve the healthiness of foodchoices in analyses of our online experiment. Remarkably, within our study population,consumers with high self-efficacy and a relative low intention to eat healthily(compared to others in our study) appeared to consult less information on energy, salt,sugar, and saturated fat. This could mean that some health-conscious consumers areoverconfident in their ability to make healthy choices. These findings jointly buildfurther on existing food choice models, and can help decision makers in public healthand food industry to understand better the complex process of food choices, especiallyin those consumers who already have an intention to eat healthily.In the general discussion of this dissertation (Chapter 6), a summary and integrationof all the (main) findings of the preceding chapter is presented. Methodological issuesare discussed, recommendations for future research and practice are given, and ageneral conclusion was drawn. We particularly focused on the role of outcomeexpectancies, nutrition literacy, and self-efficacy in food choices – which are oftenresearched in other food choice studies. Self-efficacy, in this respect, might act as adouble-edged sword. On the one hand, self-efficacy appears to operate on theformation of intentions to eat healthily, and thus in healthy food choices. On the otherhand, based on data from our study with consumers who had a high intention to eathealthily, complex food choices might not benefit from an increased self-efficacy – aspeople can become overconfident and omit to use nutrition information. These individuals might rely too much on the nutrition knowledge and beliefs that theyalready have, and make their (wrong) choices without using all available information.This needs further study.For further theory building, we recommend to replicate our studies in Chapter 4 andChapter 5 in a broad population, which does not have a high intention to eat healthily, apopulation of low-SES consumers, and a population of adolescents. Using data fromthese replication studies, new analyses can be conducted on the precise nutritioninformation attributes that these individuals consider – related to their psychosocialcharacteristics – to better understand their food choices. For practice, we argue thatfood industry should take responsibility in their role in the metabolic syndromeepidemic and use our findings to reformulate products, for instance by gradually limiting the amount of fat and added sugars in products to reduce energy density. We conclude that consumers now have access to a vast wealth of (mis)information,affecting their appetite and food choices. From both a practical and theoreticalperspective, we need to further build our understanding how this information can be optimally used to promote healthy food choices.