What are the main barriers to changing diet and lifestyle?

The prevalence of obesity in Europe has risen dramatically during the past twenty-five years, doubling and trebling in many countries1. In parts of Europe the combination of overweight and obesity has now as high as 60-70% prevalence. While obesity is a massive problem, risks to health increase progressively from well below the standard overweight threshold. Major health threats associated with overweight include type 2 diabetes, cardio-vascular diseases, some forms of cancer, as well as psycho-social problems, osteo-arthritis and a range of other co-morbidities. Poor diet and physical inactivity, even without necessarily having to translate into obesity, are poised to become the leading preventable cause of death in America, and to overtake tobacco as the number one killer 2,3.

While recognizing that obesity, poor dietary and physical activity patterns are associated with a large number of debilitating and even life-threatening disorders, many people fail to adopt habits that support healthier lives. It is a fallacy to assume that individuals at the highest risk for chronic diseases would be the ones to have the greatest internal motivation, will and passion to change their lifestyle. Many unhealthy behaviours that are common today are the ‘easy’ option – and for some, the only option4. For example, if an unhealthy food is considered cheaper, more convenient and tastier, this will significantly compromise the intention to make healthy choices.
The steps towards a change include increase in the knowledge about nutrition and exercise, and recognision of the fact that unhealthy lifestyle is a much more passive phenomenon than is often assumed4. Our basic biological instincts combined with our modern environment means that most subjects are destined to choose some habits that are unhealthy and do not support maintenance of healthy weight. Therefore, awareness of the barriers of better choices and willingness to adopt several active coping strategies, and to make long term, large scale commitments are prerequisites for a change.

Barriers to changing a lifestyle can be devided into internal and external5. Internal barriers include personal factors such as tastes and preferences, and lack of knowledge, willpower, energy or health concerns. For some, pessimistic beliefs regarding personal control over healthy weight, and for others, psychosocial problems and emotional difficulties may hinder making changes in their current lifestyle.

Families and sociocultural factors exert a strong external influence on food and exercise habits5. When parents make poor choices, children have very little power to change the family environment or attitudes. For many people, especially those on low incomes, the relatively high cost of fruits, vegetables, fish and lean meat is a major barrier to healthy eating. The perception that fruits and vegetables are time-consuming to prepare is also a frequently cited barrier, as is lack of time to practise sports. Other external factors include food availability in the schools, workplace, canteens and cafeterias: fresh salads, vegetables, fruit and other low-calorie foods are poorly accessible compared with high turnover fast foods.

There is no expectation of any spontaneous reversal of obesity trends or those of unhealthy lifestyles within our modern society. Therefore, changing the high-calorie diet with poor nutritional value and sedentary lifestyle will require concentrated and active efforts at many levels. Attempts to reverse the rising obesity trend and address the prospect of the rising health burden and societal costs will demand major changes in behaviour – not only in individuals but also in families, communities, organisations and economic markets4.

References:

1. International Obesity TaskForce; European Association for the Study of Obesity. Obesity in Europe. The Case for Action. 2002.

2. Mokdad, A. H.; Marks, J. S.; Stroup, D. F.; Gerberding, J. L. Actual Causes of Death in the United States, 2000. JAMA 2004, 291, 1238-1245.

3. Mokdad, A. H.; Marks, J. S.; Stroup, D. F.; Gerberding, J. L. Correction: Actual Causes of Death in the United States, 2000. JAMA 2005, 293, 293-294.

4. Government Office for Science. The Foresight Tackling Obesities: Future Choices - Project report. 2007.

5. Ziebland, S.; Thorogood, M.; Yudkin, P.; Jones, L.; Coulter, A. Lack of Willpower or Lack of Wherewithal? «Internal» and «External» Barriers to Changing Diet and Exercise in a Three Year Follow-Up of Participants in a Health Check. Soc. Sci. Med. 1998, 46, 461-465.