“Doing a good thing for myself”: a qualitative study of young adults’ strategies for reducing takeaway food consumption

Overconsumption of takeaway foods (TAF) has been a cause for concern for public health practitioners as they are often high in energy, total fat, saturated fat, and sodium [1]. Although what is considered to comprise this group of foods varies between studies, it is typically broader than fast food and could include cold and hot foods purchased for immediate consumption from fast food and casual restaurants, cafeterias, and snack bars. It may also include foods taken away, or delivered, from full table service restaurants and cafes (i.e. eaten elsewhere). Therefore, one broad definition of TAF has been ‘any meal prepared outside the home that, when bought, is ready-to-eat as a meal’ [2]. A recent review reported links between TAF and increased obesity, fast food and increased daily energy intake, out-of-home eating and increased saturated fat and total fat intake [3]. Despite the associated health risks, TAF constitutes a significant proportion of the diet in countries such as the US, UK and Australia [3]. For example, it has been estimated that in the UK one third of the daily energy comes from food prepared outside the home [4] and at last assessment, 36% of Australian adults consumed food prepared outside the home in a 24-h period [5]. Further, meals out and fast foods accounted for over 34% of Australian on ‘Food and non-alcoholic beverage’ household spending [6].

Young adults represent a particularly at-risk group in terms of TAF consumption and its short and long-term health sequelae. Firstly, this group are among the highest consumers of TAF in the UK, Australia and the US [7‐9] and accordingly spend more on fast food and TAF than any other age group. For example, as a proportion of ‘Food and non-alcoholic beverages’ and ‘Total goods and services expenditure’ Australian 15–24 year olds spend 19.4 and 3.0%, and 25–34 year olds spend 16.5 and 2.7%, respectively compared with 13.1 and 2.2% for all households [6]. Secondly, a prospective study of young adults aged 18–30 years in the US found that compared with infrequent consumers of fast food, those consuming fast food more than twice per week gained 4.5 kg more weight over 15 years [9]. Australian research also shows the 20–30 years age bracket is a period of acceleration in obesity rates [10] and young adulthood is associated with a generally poorer diet with low fruit and vegetable intake [11] and high consumption of sugar-sweetened beverages [12]. The most frequent consumers of TAF among young Australian adults according to one survey tend to be male, younger and single [13]. Finally, food behaviours seem to track over time and a lack of involvement in food preparation during early adulthood is associated with poorer diet quality during the mid- to late-twenties [14].

Previous research shows that changing food habits long-term towards a healthier pattern may be difficult. For example, Australian research indicated that a variety of factors support continuation of energy-dense beverage consumption such as feeling part of a social group, competitive pricing versus non-energy dense options and the health consequences of consumption being considered remote and not personally relevant [15]. Other research showed similar themes, but also noted how negative constructions of healthy food amongst adolescents as without taste and healthy eating as an unpleasant, short-term activity further shored up the attractiveness of energy-dense foods. Little formative research, however, has been conducted on how young Australians can change [16] and how health promotion programs may be better designed to support this behaviour. By contrast with previous research addressing barriers [15, 16], here we describe strategies and other factors reported by young adults who believe themselves to have been successful in decreasing their consumption of TAF in order to elucidate how they have overcome such barriers.

Research has shown that young people report challenges in trying to reduce the amount of TAF they consume [26]. Factors such as perceived lower cost, taste, and convenience are cited as reasons which guide them towards choosing energy-dense TAF and away from healthier homemade options [27‐29]. The current study describes a number of strategies that young people, who report reducing their TAF consumption, have found useful in navigating those barriers. These include increasing awareness of their own worth and individual identity as a healthy person; knowledge that TAF does not cost less than healthier foods; setting personally specific, achievable, timely goals; creating opportunities to avoid TAF by planning meals ahead and improving their food environment; and deriving motivation through social support and reconfiguring their social networks to enable improved meal choices. The strategies used address the attractions and justifications for consuming TAF. For example, where TAF is convenient, planning makes a home-cooked meal more convenient; where social interaction involves TAF, a communal cooking effort confers a social dividend; where TAF is a reward, a healthy choice is being good to oneself; where the rate of consumption is invisible, rule-making renders it visible and auditable; and finally, where TAF is seen as time and cost-efficient, cooking home-made food ahead and in bulk yields time and cost savings.

The informal strategies described by the participants resonate with other research including those that have reviewed and/or tested more formal behaviour change approaches to weight loss and/or promotion of healthy eating. For example, corresponding to our rule-making (2.2) and reaching a goal (1.2) sub-themes two systematic reviews have found that interventions that promote self-monitoring and goal setting are effective in achieving healthier eating [30, 31]. In a meta-analysis of randomised controlled trials, these factors were found to be independent predictors of short (≤6 months) and long (≥12 months) term dietary and/or physical activity improvements, although these trials were conducted in overweight and obese adults [30]. In terms of a mechanism, making rules about food consumption fosters self-regulation, a noted enabler for weight management, by setting boundaries around eating behaviour [31]. To follow the rule, one must both self-monitor one’s behaviour for compliance and compare the behaviour to the desired behaviour. With respect to goal-setting, this is most often described in terms wanting to reach a certain weight or some other risk factor or health goal [25]. Of interest here, is that the goals described by our participants were not solely related to eating behaviour but other priorities such as weight loss for a personal purpose like a wedding or pregnancy planning. Therefore, interventions aimed at reducing TAF consumption which is defined in terms of a behaviour (e.g., eat fewer takeaway meals) may perhaps be most effective when linked with other personally relevant but non-health related goals.

Samdal et al. [30] also found the behaviour change techniques of graded tasks and barrier identification/problem solving to be significant predictors of healthy eating in the short term which correspond to our small changes (1.4) and modifying social interaction sub-themes (4.0). Graded tasks break down a target behaviour into short term steps (e.g., buy a healthier option this one time) which people may find easier to adhere to, and in the case of our participants, to imagine themselves performing than a broader long term goal (reduce TAF consumption). Wing et al. (2016) have also shown that small changes in food intake and physical activity can prevent weight gain as shown in a group followed for up to three years [32]. Thus, the strategy suggested by the participants in the current study may prove effective for improving their diet longer term. Problem solving, on the other hand, requires thinking ahead about potential barriers to a long term behaviour goal and generating a solution [25]. As noted by the participants in our study, during adolescence eating TAF becomes a social norm and peer group pressure to eat these foods is strong and this may persist during young adulthood [33]. The participants anticipated being exposed to TAF and put strategies into place that could still bring them social benefits without having to consume unhealthy TAF by either inconspicuously not eating the food or participating in communal cooking. Young people willing to use these strategies could be further assisted through more supportive public food environments (see discussion below).

In agreement with previous survey research, we found that time [28, 34] and cost [23, 35] were two factors drawing participants to TAF. However, with respect to the former while these participants acknowledged the convenience of TAF, they reported planning ahead could counteract the need for it. Australian research has demonstrated that allocating less time to eating can predispose to higher TAF consumption [8]. In focus groups with college students in the US, researchers identified that having time to plan to shop, cook and clean up after meals was a motivator to home food preparation and home cooking could save money [36]. Therefore, time management and availability seem to be key factors to be taken into account when planning interventions for young adults to reduce TAF consumption. Knowledge of the true comparative costs may additionally be considered an enabling factor motivating them to avoid TAF as also postulated by others [37].

Our findings have also resonated with a number of qualitative studies examining healthy eating. For example, the cognitive recasting which these participants described which repositioned not eating TAF as “doing a good thing for myself” (Table 1) is consistent with a qualitative study of 40 adolescents and young adults who had successfully lost weight. [38]. The authors contend that the primary motivation to make changes to diet and physical activity was an internally derived desire for better health and elevated their sense of their own self-worth. Another study used focus groups with adults (mean age 34.2 years) in Ireland to investigate their views on views about what influenced portion size selection and management. Participants reported purposefully buying food (not just TAF) in portion-controlled sizes or portioning and storing appropriate serving sizes was one strategy to assist better portion control [39]. Whilst TAF presents some particular challenges as portion sizes are often excessive [40], our participants exercised very similar approaches by reducing how much they served to themselves and storing the remainder or sharing their takeaway meal. However, the complaint that they were prohibited from buying the inherently smaller “kids portion” speaks to the importance of the wider food supply system and how individual intentions are situated within broader contexts and therefore somewhat constrained in a more or less supportive environment.

When people are hungry they will eat what is available and therefore food environments where consumers have reduced control over selection are extremely important in influencing diet. In the Coronary Artery Risk Development in Young Adults cohort for example, low income respondents’ proximity to fast food restaurants was positively associated with consumption [41], although others have found no relationship between the frequency of fast food consumption and proximity to outlets [42]. Whether recognition prompts intake or internal motivation makes one more observant of food sources is uncertain but the range of foods in physical and temporal space limited the ease with which our participants could minimise TAF consumption. They did, however, recognise both the chains selling more nutritious food and the addition of healthy items to the menus of food chains with menus predominated by high energy, high saturated fat, high sodium foods. Some also said that menu-labelling influenced their choices. A study undertaken at the same University from which the current sample was recruited found that awareness of the labelling after some social marketing was just over 40% but for those who noticed and wanted to use the information (9%) it did result in lower energy food selections [43]. Nikolaou et al. (2014) found calorie-labelling in a university-cafeteria resulted in 3.5 kg less weight gain in students over a one year period [44]. Therefore, whilst food environments vary widely in terms of how much they may challenge an individual’s commitment to reducing TAF, providing healthier menu items and nutritional information at least broadens opportunities if not selected options.

What is salient about the strategies and factors described here is that they traverse the spectrum of the social-ecological model, especially as explicated by Fitzgerald and Spaccarotella (2009) [45]. This model posits that health-related behaviours are affected by factors operating at different levels from the personal characteristics of individuals to the macrosystems of culture and public policy. Our participants referenced intrapersonal strategies on perceptions and knowledge and skills through the cognitive recasting and using the caloric and financial cost of TAF to motivate change. They also referred to strategies which were interpersonal; benefitting (albeit passively) from positive social support but also actively changing food availability where they could and building social relations which supported healthy eating. Moving further outward in the model, they modified portion sizes and engaged with problem solved in food environments external to the home. Finally, their strategies interacted with broader culture as they sought to find ways to still participate but still not consume TAF. Importantly this means that in order to support the types of strategies that young adults might find appropriate, those support strategies need to operate at a range of levels and not merely involve individual education as many programs do [46].

The issue of agency is pertinent here. Whilst on the one hand many of the strategies and techniques described by our participants were highly agentic [46] in that the participants talked about drawing on their own resources to change, those solutions may be augmented and perhaps rendered more powerful if they are surrounded by supportive multilevel action. For example, young people’s desire to take care of their health through healthy eating but have no time to home-prepare food can be assisted by providing mostly healthy food options in places which they frequent such as tertiary education institutions. A desire for convenient, affordable social eating might be supported by facilities that network young people for communal cooking. In other words, high agency actions may be further supported by low agency environmental restructuring which may incrementally increase the probability of a healthy choice. Although some of our participants implied a need for macrolevel change, given the importance of autonomy to this subpopulation with respect to their health [38] and the comparatively lower acceptability of government-led diet interventions restricting or eliminating choice [47] careful consideration would need to be given to framing and implementation.

The insights gained through this analysis provide new and useful information from which interventions may be planned in future to offset the perceived barriers to eating less TAF. The strength of the study is that we have used the reported experiences of young adults themselves to inform solutions. Further, the strategies were from those who report that they have successfully reduced their consumption and therefore reflected mechanisms that had been generated under real-world circumstances. There are however some limitations of the current study. The scope of the findings are limited by the low numbers of males and overweight or obese participants. Hence, the range of strategies to reduce TAF among these groups may not have been fully captured in our focus groups. The students mostly lived in areas of higher socioeconomic status (although they themselves mostly were not earning high incomes) and involved in tertiary education. Therefore, they may have been able to draw on resources which other subpopulations may not and the strategies identified here may not be successfully implemented by young adults from different socioeconomic and educational backgrounds. Initially we recruited participants who were female and eating very healthy diets with minimal intake of TAF and therefore we needed to re-focus the recruitment strategy to gain new insights from consumers. However, it is not unusual for sampling strategies to change in response to preliminary analysis in qualitative research and indeed is important they do so in order to maximise saturation [48]. Finally, this is analysis is formative and any intervention developed from these data would require an evaluation of effectiveness and scalability to population level.

Young people can and do reduce their consumption of TAF successfully using a range of strategies that address not only the attractions of TAF, but the apparent disincentives for reducing consumption. Interventions directed at the individual level should include goal-setting, self-monitoring, nutrition education to discern between unhealthy and healthy TAF to increase skills and confidence in preparing nutritious meals, as well as tapping into a person’s instrinsic motivation to change. Recommendations for environmental level change include increasing the availability of healthy alternatives, reducing the cost of healthy choices in line with or below the price of unhealthy options, and introducing labelling to help the quick identification of healthy choices. Building a social and wider food environment supportive of the healthy food choices an individual aspires to, may provide a valuable leverage point to work against many of the attractions of TAF.