Perceptions of the causes of obesity among normal weight, overweight and obese Indonesian women: a mixed methods approach

@# Introduction: Overweight and obesity (OW/OB) among adults is a public health concern in Indonesia. While OW/OB is generally attributed to consumption in excess of expended energy, understanding the perceptions of the causes of obesity among OW/OB individuals may provide insights for developing appropriate obesity-reduction interventions. Methods: This study used a mixed methods approach, comprising a quantitative online survey and in-depth interviews. The online “International Families and Food Survey” was conducted in 2014 by Global Market Insite (GMI) to elicit response of Indonesian women to 12 likely causes of obesity, based on a 5-point rating ranging from ‘definitely disagree’ to ‘definitely agree’. A total of 377 respondents aged 18-49 years from Jakarta participated, comprising 221 normal weight (NW) and 156 OW/OB based on World Health Organization (WHO) cut-offs. Additional 16 informants who fulfilled the inclusion criteria were recruited for indepth interviews to gather further insights on causes of obesity. Logistic regression was conducted to assess the likelihood of socioeconomic factors in predicting “agreement on the likely causes of obesity”. Results: The online survey showed that the NW and OW/OB respondents provided quite similar rating response to each of the likely causes of obesity. Unmarried and middle socioeconomic status (SES) respondents were significantly more likely to agree on the perceived causes of obesity, compared to married and high SES. In-depth interviews revealed OW/OB informants attributed obesity to environmental factors, compared to individual factors attributed by NW informants. Conclusion: Use of mixed methods approach provided insights for the development of obesity-reduction interventions among Indonesian adult women.

Exposure and approval of food marketing strategies: a mixed methods study among household food providers in Jakarta

@# Introduction: Food marketing influences consumers’ food choices leading to unplanned food purchasing. Methods: This study used a mixed methods approach to investigate the association between food marketing exposure and approval of food marketing strategies among household food providers in Jakarta. Responses from 279 survey participants to questions on exposure and their approval of marketing strategies were analysed. An additional 16 informants who fulfilled the inclusion criteria were recruited for the in-depth interview. Logistic regression was conducted to assess the relationship between the categorical predictor variable (“exposure to active or passive marketing”) and the categorical outcome variable (“approval response to food marketing strategies”). Results: Almost half of the respondents reported not having exposure to active marketing in the past month, whereas approximately one-third had experienced such exposure 1-2 times. Most of the respondents disapproved the marketing of fast foods and sugar-sweetened foods. The highest disapproval was for the placement of vending machines carrying such foods in schools (69.9%). Respondents who were exposed to active marketing at least once in the previous month were 1.99 times more likely (AOR; 95% CI: 1.07-3.73) to approve the marketing of unhealthy foods. Conclusion: Exposure to food marketing promotion appeared to influence approval of marketing strategies among household food providers in Jakarta. In-depth interviews provided supportive evidence for the quantitative results. A mixed methods approach is suggested for larger studies to confirm these findings.

Food purchasing behaviour among urban slum women in East Jakarta: a qualitative study

@# Introduction: Urbanisation in Indonesia has been associated with a transition in nutrition which has been, in part, marked by an increased purchasing of readyto-eat, energy-dense, nutrient-poor foods. Women are responsible for purchasing and preparing food for the family. Their purchasing behaviours differ in various environments and population groups. This qualitative study was undertaken to explore the food environmental factors that influenced food purchasing behaviour of women who were the household food gatekeepers. Methods: The study was conducted in a slum area in East Jakarta. Eighteen overweight-obese and nonobese women who fulfilled the study’s inclusion criteria were recruited for interviews that used a semi-structured questionnaire. Emic observations were conducted in order to identify typical food purchasing activities. The data were coded and categorised using qualitative data analysis and research software (Atlas.ti 7 for Windows). Results: Most of the women purchased ready-to-eat foods rather than cook at home, either for the family or their own consumption. Several food environmental factors influenced women’s purchasing behaviour, including time and cost efficiency, food availability, family, exposure to ready-to-eat foods and food store marketing strategies. These factors led to the consumption of unhealthy foods that were high in fat, carbohydrate, sugar and salt that some of which may cause obesity. Conclusion: Purchasing unhealthy food was observed to be strongly linked with food-related environmental factors. This study provides an understanding of women’s food purchasing behaviour and highlight potential ways to foster healthier purchasing behaviour among urban slum dwellers.