Coping strategies of food insecure households with children and adolescents in Uruguay, a high-income Latin American country: A qualitative study through the lens of Bourdieu's theories of capitals and practice.

Food insecurity has been associated with negative short, medium, and long-term health consequences, which are more detrimental for children and adolescents. These effects may depend on the coping strategies developed to deal with food shortages. The present research aimed at exploring coping strategies in food insecure households with children and adolescents in Uruguay, incorporating sociological theoretical insights from Bourdieu. A qualitative approach based on individual semi-structured interviews was used. A total of 40 interviews were conducted with adults who had parental responsibilities of children and adolescents and who received different types of food assistance, between July and December 2022, in four cities. Results showed that adults tend to develop a wide range of coping strategies aimed at: reducing food expenditure, increasing the availability of money for purchasing food, increasing food availability and/or rationing the food available in the household. Some of the strategies were implemented regardless of the severity of food insecurity, whereas others were characteristic of the moderate and severe levels of the construct. Evidence to support the mediation effect of coping strategies on health outcomes was found. Discourses suggested that lower accumulation of economic and cultural capital may be aligned with the adoption of less socially accepted mechanisms to access to food. Expressions of a specific habitus aimed at securing food were identified among participants with more deprivations. Taken together, the findings suggest that coping strategies may not be a universal or invariant sequence according to the severity of food insecurity and stress the importance of considering households' resources and local context for the development of strategies to improve access to food.

Health-Washing of Ultraprocessed Products on Instagram: Prevalence and Strategies in an Emerging Market.

OBJECTIVE: To evaluate the prevalence of health-related cues as part of the digital marketing of ultraprocessed foods on Instagram among food companies in Uruguay. METHODS: Cross-sectional exploratory study. All content posted by 118 Instagram accounts of companies promoting ultraprocessed foods in Uruguay over 6 months (from August 2020 to February 2021) was retrieved. The content of 1,893 Instagram posts was coded considering visual and textual cues conveying health-related associations. The number and percentage of posts, including cues within each category and theme, were calculated. RESULTS: More than half of all posts contained at least 1 visual or textual cue conveying health-related associations. Three main themes emerged: i) product composition, ii) healthy lifestyle, and iii) health and health benefits. The prevalence of health-related cues differed dramatically across product categories, ranging from 100% to 1.5%. CONCLUSIONS AND IMPLICATIONS: Health-washing constitutes an integral part of the digital marketing of ultraprocessed foods on Instagram in Uruguay. The inclusion of health-related cues can potentially undermine public health efforts targeted at reducing consumption of these foods. These findings suggest that strict and comprehensive regulations on the digital marketing of such products are needed in policies promoting healthy eating habits globally.

Parent Experiences With Warning Labels After Policy Implementation in Uruguay.

OBJECTIVE: To explore the perception and experiences of parents of children and adolescents during the first year of the mandatory implementation of nutritional warning labels in Uruguay. DESIGN: Qualitative research based on semistructured interviews. SETTING: Montevideo, Uruguay. PARTICIPANTS: Twenty-eight parents of children and adolescents. PHENOMENON OF INTEREST: Perception of and experiences with warning labels, a front-of-pack nutrition labeling scheme that has become increasingly popular in Latin America. ANALYSIS: Content analysis of the transcripts based on a deductive-inductive approach. RESULTS: Interview transcripts evidenced high awareness, acceptance, and understanding of warning labels among parents of children and adolescents. Most participants reported considering warnings for decision making and changing their purchase decisions because of their implementation, particularly when choosing foods for their children. They reported their children were aware of and understood warnings but did not tend to take them into account when choosing foods. CONCLUSIONS AND IMPLICATIONS: Results from the present work contribute to the growing body of literature showing the effectiveness of warning labels. Lack of interest or perceived benefits and structural barriers emerged as key motives for not using the warnings when making purchasing decisions, suggesting the need to develop additional strategies to increase policy effectiveness.

Use of nutritional warning labels at the point of purchase: An exploratory study using self-reported measures and eye-tracking.

Nutritional warning labels are gaining relevance in the region of the Americas as a policy tool to reduce information asymmetry and encourage healthier food choices. However, empirical evidence about consumer experiences with warning labels after implementation is still scarce. In this context, the aim of the present work was to explore the use of nutritional warning labels after policy implementation in Uruguay, using a combination of eye-tracking and self-reported data. The study was conducted in three supermarkets, in two regional capitals, 19 months after the entry into force of the policy. A total of 224 participants were intercepted while entering the facilities of the supermarket and asked to wear a mobile eye-tracker while making their food purchases. Then, they were asked a series of questions about their awareness and use of warning labels. Although participants reported high awareness and understanding of the labels, active search and use at the point of purchase was low. Only 6% of the consumers declared having actively searched for the warning labels and 7% fixated their gaze on the labels. The majority of the participants (72%) who declared having seen the warnings on a product, purchased it anyway. However, 56% declared having changed their food choice decisions as a consequence of the implementation of the policy. Participants' accounts about reasons for (not) taking into account the warning labels provide relevant insights for the development of strategies to encourage citizens to increase policy effectiveness and encourage healthier food choices.

The content of Instagram posts featuring ultra-processed products through the lens of the heuristic-systematic model.

Digital marketing has seen a rapid rise in the last decade as a consequence of the increased popularity of social media. However, few studies so far have analyzed the prevalence and persuasive power of digital marketing of ultra-processed products. The present study aimed at: (i) analyzing the content of Instagram posts of ultra-processed products through the lens of the heuristic-systematic model, and (ii) evaluating the influence of the content of the posts on user interactions. A search for Instagram accounts of ultra-processed products was performed using a master list of products commercialized in the two most popular online supermarkets in Uruguay. For each of the identified Instagram accounts, all the content posted in a 6-month period was recorded (August 15th, 2020 to February 15th, 2021). The posts were analyzed using content analysis based on inductive coding, and gradient boosting models (GBMs) were used to address the second study objective. A total of 2178 Instagram posts promoting specific ultra-processed products or brands were identified. The posts included a diverse set of cues to trigger both systematic and heuristic processing. References to the pleasure derived from product consumption as well as health-related cues were most prevalent. The GBM showed that references to contests and raffles and invitations to interact encouraged users to engage with the posts through posting comments. Taken together, results stress the need to implement comprehensive regulatory approaches to reduce exposure to and the power of digital marketing of ultra-processed products given the harmful health-related consequences associated with excessive consumption of such products.

Health-related cues on the packages of processed and ultra-processed products: prevalence and policy implications.

The information included on food packages has a crucial role in influencing consumer product associations and purchase decisions. In particular, visual and textual cues on processed and ultra-processed products can convey health-related associations that influence consumer healthiness perception and purchase decisions. In this context, the present work aimed to explore the use of health-related cues on the packages of processed and ultra-processed products sold in Uruguay to provide insights for policy making. A total of 3813 products from thirty-four different food categories found in four of the most important supermarket chains in Uruguay were surveyed. The textual and visual information included on the packages as well as the nutritional composition of the products were analysed. Results showed that 67 % of the products included at least one health-related cue. Pictures of culinary ingredients, natural and minimally processed foods were the most frequent health-related cue, followed by references to naturalness and claims related to critical nutrients. The prevalence of health-related cues largely differed across product categories, ranging from 100 to 17 %. The relationship between the presence of health-related cues on the packages and the excessive content of nutrients associated with non-communicable diseases was assessed using a gradient boosting model, which showed limited predictive ability. This suggests that the inclusion of health-related cues on food packages was not strongly related to the nutritional composition of products and therefore cannot be regarded as a healthiness indicator. These results stress the need to develop stricter labelling regulations to protect consumers from misleading information.

A Qualitative Exploration of Parents' Food Choices During Early Childhood.

OBJECTIVE: To explore parents' accounts of the goals they seek when choosing foods for their young children through the lens of goal-systems theory. DESIGN: In-depth interviews with parents of children aged from 6 months to 5 years. SETTING: Montevideo, Uruguay. PARTICIPANTS: Forty-two parents (aged 19-44 years, 90% female). PHENOMENON OF INTEREST: Parents' personal experiences, feelings, and opinions related to how they choose foods for their children. ANALYSIS: Content analysis based on deductive-inductive coding. RESULTS: Parents' accounts confirmed they intended to pursue different goals when choosing foods for their children. Health-related goals mainly motivated the selection of healthy foods, but they also drove the selection of some ultra-processed products because of misconceptions about their healthiness. Pleasure and enjoyment motivated the selection of ultra-processed products, whereas stress avoidance was associated with selecting convenient foods. The selection of unhealthy foods raised conflicts between goals, which were solved using goal shielding, changes in risk perception and/or compensatory health beliefs. CONCLUSIONS AND IMPLICATIONS: Results point to the need for communication campaigns and community-based interventions to introduce changes in how ultra-processed products are conceptualized and increase the associations between healthy foods and children's pleasure and enjoyment to promote healthier eating patterns during infancy and early childhood.

The contributions of civil society to food security in the context of COVID-19: a qualitative exploration in Uruguay.

OBJECTIVE: The aim of this study was to explore and analyse the actions implemented by civil society to contribute to food security in the context of the COVID-19 outbreak in Uruguay, a high-income country in South America. DESIGN: An exploratory systematic approach was used to identify the contributions of civil society to food security through reports in news websites and Facebook posts. Data were analysed based on content analysis following a deductive-inductive approach. SETTING: Uruguay, Latin America. RESULTS: A total of 1220 civil society organisations were identified, which developed two main actions to increase access to food among the Uruguayan population: food baskets and 'community pots' (also known as 'common pots'). Most of the initiatives targeted citizens under socioeconomic vulnerability in the face of COVID-19, without specifying any specific requirement or population segment. Actions were mainly led by spontaneously organised community groups, and, to a lesser extent, by consolidated organisations. Interactions between organisations were identified. The foods provided by the organisations were mostly aligned with national dietary guidelines. Social media posts evidenced that the main challenge faced by organisations was related to the lack of funds or supplies. CONCLUSIONS: Results from this work suggest that the lack of funds or supplies poses challenges to the medium- and long-term contributions of civil society to food security and stresses the need for comprehensive governmental measures to guarantee food security amongst Uruguayan citizens.

Do nutritional warnings encourage healthier choices on food ordering websites? An exploratory experimental study in Uruguay.

OBJECTIVE: To evaluate if the inclusion of nutritional warnings in food ordering websites can discourage consumers from purchasing foods with excessive content of nutrients associated with non-communicable diseases (NCD). DESIGN: Participants were randomly assigned to one of the two experimental conditions: control (n 225) or nutritional warnings (n 222). Nutritional warnings corresponded to separate black octagonal signs containing the word 'Excess' followed by the corresponding nutrient: total fat, saturated fat, sugars and sodium. Participants were asked to purchase a lunch for themselves using a simulated food ordering website. SETTING: Online study in Uruguay. PARTICIPANTS: Convenience sample of 447 Uruguayan participants, recruited using social media. RESULTS: In the control condition, 76 % of the participants selected a dish or a beverage with excessive content of at least one nutrient in the simulated food ordering website. When nutritional warnings were included, this percentage significantly decreased to 62 % (P = 0·002). In addition, nutritional warnings caused a significant reduction in the percentage of participants who selected dishes with excessive content of total fat: 50 % v. 62 % (P = 0·012). CONCLUSIONS: Results from the present work provide preliminary evidence that the inclusion of nutritional warnings in food ordering websites could discourage consumers from selecting dishes and beverages with excessive content of nutrients associated with NCD.

The heuristics that guide healthiness perception of ultra-processed foods: a qualitative exploration.

OBJECTIVE: To explore the conceptualisation of healthy food by citizens and how they judge the healthiness of ultra-processed foods. DESIGN: Four focus groups were conducted using a semi-structured discussion guide. Focus group discussions were held about the concept of healthy food, what characterise a healthy product and healthiness perception of ultra-processed products. Transcripts of the focus groups were analysed following an inductive coding approach. SETTING: Uruguay, one of the Latin American countries with the highest prevalence of overweight and obesity. PARTICIPANTS: Fifty-two adult Uruguayan participants, diverse in terms of gender, age, educational level and socio-economic status. RESULTS: In agreement with previous studies on lay perceptions of healthy eating, the conceptualisation of healthy food was mainly focused on food characteristics. Although participants regarded lack of processing as a cue for healthiness, they did not categorise all ultra-processed products as unhealthy. Albeit some product categories were automatically regarded as unhealthy, participants considered that other categories could include healthy and unhealthy products. In such cases, they explicitly referred to several simplified cognitive strategies to judge whether an ultra-processed product is healthy or not. Results showed that participants tended to rely on simple cues, such as label design, nutrient claims, brand, price and country of origin as indicators of product healthiness. CONCLUSIONS: Healthiness perception of ultra-processed products seems to be largely influenced by heuristics, which stresses the need to implement policies that make the potential negative effects of ultra-processed products salient.

The habitual nature of food purchases at the supermarket: Implications for policy making.

Supermarkets have become the most important provider of food products worldwide. However, empirical evidence about how consumers make their food purchase decisions in this environment is still scarce. The present field study aimed to: i) explore how people make their in-store food purchases, and ii) identify the information they search for when making those purchases. Consumers (n = 144) were intercepted when entering the facilities of three supermarkets in two Uruguayan cities. They were asked to wear a mobile eye-tracker while they made their purchases as they normally do. The great majority of the consumers bought at least one food product or beverage (92%) and, on average, examined products from 2.8 sections. In total, they investigated 37 categories within 13 self-service sections, corresponding to 26 categories of ultra-processed products. For 67% of the products, consumers went straight to the product they seemed to be looking for, grabbed it and put it in their shopping basket or cart, without making any comparison among products. A limited information search was observed. On average, consumers spent 22 s examining products within self-service sections and only 6.9 s were elapsed from the moment they grabbed a product until they put it in the shopping cart. These results provide empirical evidence of the habitual nature of supermarket food purchases in a context characterized by wide availability of ultra-processed products. Taken together, the findings suggest that policies and interventions aimed at reducing purchases of ultra-processed products should disrupt habitual decisions at the point of purchase. In this sense, policies targeted at introducing salient changes on food packages hold potential to disrupt food purchases and encourage consumers to establish new and more healthful food purchase habits.

Uruguayan Citizens' Perception of Messages to Promote Healthy Eating Through the Use of Nutritional Warnings.

OBJECTIVE: To explore the specific type of messages people consider most appropriate for a mass communication campaign aimed to promote healthy eating in the context of the implementation of nutritional warnings. DESIGN: Online study including multiple-choice and open-ended questions. SETTING: Uruguay, 1 of the Latin American countries with the highest prevalence of overweight and obesity. PARTICIPANTS: A total of 859 participants were recruited using social media. They were diverse in terms of gender, age, educational level, socioeconomic status, and self-reported body mass index. PHENOMENON OF INTEREST: Participants were presented with 3 series of messages and were asked to select the 1 they perceived as the most appropriate and to provide a brief explanation for their selection. ANALYSIS: Descriptive statistics for the multiple-choice questions and inductive coding for the responses to the open-ended questions. RESULTS: Participants tended to prefer messages that conveyed a cue to action for achieving changes to their perceived ability to make healthful food choices. Although messages related to the promotion of informed food choices were the most frequently preferred, messages related to negative health consequences and health benefits were also selected repetitively. CONCLUSIONS AND IMPLICATIONS: Communication campaigns aimed at promoting healthy eating through the use of nutritional warnings could include different contents to target specific segments with different motivations.

Social representations of breastfeeding and infant formula: An exploratory study with mothers and health professionals to inform policy making.

Although several efforts to promote breastfeeding have been implemented worldwide, the prevalence of exclusive breastfeeding in the first 6 months of life remains low. One of the factors responsible for this trend is the widespread sales and marketing of breast-milk substitutes. In this context, the present work aimed at exploring mothers and health professionals' social representations of breastfeeding and infant formula. The study was conducted in Montevideo (Uruguay), as part of the periodic assessment performed by the Uruguayan government to monitor the marketing of breast-milk substitutes according to the OMS/UNICEF NetCode toolkit. A total of 330 mothers of children under 24 months old and 154 health professionals were recruited at 33 health care facilities. Participants were asked to complete two word association tasks, one with breastfeeding and the other with infant formula. Inductive coding was used to classify the responses into categories and dimensions. The structure of the social representations was explored considering the frequency of mention and the average rank of appearance of the categories. Results showed that mothers' social representations mainly positioned breastfeeding as a feeding practice, whereas infant formulas were mainly perceived as a complement to breast-milk that provides support. In the case of health professionals, the social representations of breastfeeding and infant formulas were in line with scientific evidence and health recommendations. These results suggest that efforts to promote breastfeeding should focus on raising public awareness of the risks associated with breast-milk substitutes and on overcoming the systemic barriers to breastfeeding, particularly among working mothers.

How Can We Motivate People to Use Nutritional Warnings in Decision Making? Citizen Co-Created Insights for the Development of Communication Campaigns.

Nutritional warnings are intended to enable citizens to make informed choice by clearly identifying food products with excessive content of nutrients associated with noncommunicable diseases. The efficacy of this public policy is expected to improve if accompanied by communication campaigns that raise awareness of the existence of nutritional warnings, as well as encourage citizens to take them into account in decision making. Because ordinary citizens have been shown to generate significantly more creative and valuable ideas than advanced users and professional developers, the aim of the present work was to obtain qualitative, citizen co-created insights for the design of a communication campaign. An online study was conducted with 518 Uruguayan citizens, recruited using a Facebook advertisement. Participants were asked to answer a series of open-ended questions about how they would encourage other people to use the warnings for making their food choices, as well as the key contents of a communication campaign. Responses were analyzed using content analysis. Results showed that, according to the participants' accounts, an effective public awareness campaign aimed at promoting the use of nutritional warnings in decision making should include three main concepts: (a) position warnings as a cue to action for improving eating habits by enabling informed choices; (b) emphasize the benefits of using the warnings for avoiding consumption of unhealthy food and, consequently, achieving a healthier diet and an improvement in health status and quality of life; and (c) increase the perceived susceptibility and severity of the negative consequences of consumption of foods with excessive content of sugar, fat, and sodium. A communication campaign based on these key concepts could contribute to increasing the efficacy of nutritional warnings.

Does message framing matter for promoting the use of nutritional warnings in decision making?

OBJECTIVE: To evaluate the impact of message framing on attitudes towards messages aimed at promoting the use of nutritional warnings, behavioural intention and actual behaviour, evaluated through visual attention to nutritional warnings and the choice of a snack product during a real choice task. DESIGN: Following a between-subjects design, participants were exposed to loss-framed nutrition messages, gain-framed nutrition messages or non-nutrition-related messages (control group). After evaluating the messages, participants were asked to select a snack product as a compensation for their participation. The experiment was conducted using an eye tracker. SETTING: Montevideo (Uruguay). PARTICIPANTS: Convenience sample of 201 people (18-51 years old, 58 % female). RESULTS: The average percentage of participants who fixated their gaze on the nutritional warnings during the choice task was slightly but significantly higher for participants who attended to nutrition messages (regardless of their framing) compared with the control group. Participants who attended to loss-framed messages fixated their gaze on the warnings for the longest period of time. In addition, the healthfulness of the snack choices was higher for participants exposed to nutrition-related messages compared with the control group. CONCLUSIONS: Results from the present work suggest that nutrition messages aimed at increasing awareness of nutritional warnings may increase consumers' visual attention and encourage more heathful choices. The framing of the messages only had a minor effect on their efficacy.

Relative Impact of Nutritional Warnings and Other Label Features on Cereal Bar Healthfulness Evaluations.

OBJECTIVE: To investigate the relative influence of nutritional warnings and 2 marketing strategies commonly used in food labels, nutrient claims, and fruit images on consumers' healthfulness judgments. DESIGN: Labels of cereal bars were designed according to a full factorial design with 3 2-level variables: images of fruit (with vs without), nutrient claims about the fiber content (with vs without), and nutritional warnings about excessive content of sugar and saturated fat (with vs without). SETTING: Experiment conducted in Montevideo, Uruguay. PARTICIPANTS: One hundred Uruguayan people, 75% female, aged 18-56 years. MAIN OUTCOME MEASURES: Healthfulness perception and eye-tracking variables. ANALYSIS: The researchers used ANOVA to evaluate the influence of the experimental design's variables on perceived healthfulness and eye-tracking measures. RESULTS: Nutritional warnings caught participants' attention and reduced the amount of visual attention needed to evaluate healthfulness. Participants mainly relied on nutritional warnings to make healthfulness judgments. CONCLUSIONS AND IMPLICATIONS: Findings of the current work confirm the potential of nutritional warnings to influence consumers' healthfulness perception, overriding the effect of other label cues used by the food industry to convey the concept of healthfulness.

Influence of nutritional warnings and other label features on consumers' choice: Results from an eye-tracking study.

Nutritional warnings highlighting products with high content of nutrients associated with non-communicable diseases have emerged as a potentially efficient alternative to discourage consumption of unhealthful products. However, the relative influence of this front-of-pack nutrition information scheme compared to other label features is still under researched. In this context, the aim of the present work was to study the influence of nutritional warnings and other information commonly displayed on food labels to convey health associations on consumers' choice and visual attention. A choice-conjoint study using labels of cookies and crackers was implemented considering the following three variables: front-of-pack nutrition information (nutritional warnings vs. facts up front panel), nutrient claim (present vs. absent) and type of product (conveying health vs. hedonic associations). A total of 124 people completed the task using the monitor of an eye-tracker. Participants were asked to select the label they would prefer to buy if they were in a supermarket. Nutritional warnings were efficient in attracting consumers' attention and required less time and fewer fixations to process than the facts up front panel. In addition, their inclusion on the labels significantly discouraged consumers' choice of labels. However, type of product was the most important variable influencing the choice of both cookies and crackers. Results from the present work confirm the potential of nutritional warnings as directive front-of-pack nutrition labelling scheme and stress that they cannot be expected to cause radical changes in consumers' eating habits due to their competition with other product features. Instead, they are expected to encourage consumers to select the most healthful option within a product category.

Traffic Light System Can Increase Healthfulness Perception: Implications for Policy Making.

OBJECTIVE: To evaluate how information about low nutrient content included in the traffic light labeling system influences consumers' perception of the healthfulness of products with high content of 1 key nutrient, and to compare the traffic light system with warnings in terms of the perception of healthfulness. DESIGN: Images of front-of-pack (FOP) nutrition labels (the traffic light labeling system with different numbers of nutrients with low content, and warnings) were evaluated in study 1, whereas product labels featuring the different FOP nutrition labels were evaluated in study 2. SETTING: Online studies conducted in Montevideo, Uruguay. PARTICIPANTS: A total of 1,228 Uruguayan Facebook users. MAIN OUTCOME MEASURES: Perception of healthfulness. ANALYSIS: The researchers used ANOVA to evaluate the influence of FOP nutrition labels on perceived healthfulness. RESULTS: The inclusion of information about low nutrient content in the traffic light system statistically significantly increased the perception of the healthfulness of products with high nutrient content. Nutritional warnings showed healthfulness ratings similar to those of the simplified version of the traffic light system. CONCLUSIONS AND IMPLICATIONS: Information about low nutrient content in the traffic light system might be used to infer health, and thus could raise the perception of healthfulness and decrease the traffic light system's efficacy in discouraging the consumption of unhealthful products. A simplified version of the traffic light highlighting only high-nutrient content or nutritional warnings seems to overcome this problem.

Product reformulation in the context of nutritional warning labels: Exploration of consumer preferences towards food concepts in three food categories.

The reformulation of the food products available in the marketplace to improve their nutritional quality has been identified as one of the most cost-effective policies for controlling the global obesity pandemic. Front-of-pack (FOP) nutrition labelling is one of the strategies that has been suggested to encourage the food industry to reformulate their products. However, the extent to which certain FOP labels can encourage product reformulation is dependent on consumer reaction. The aim of the present work was to assess consumers' perception towards product reformulation in the context of the implementation of nutritional warnings, an interpretive FOP nutrition labelling scheme. Three product categories were selected as target products: bread, cream cheese and yogurt, each associated with high content of one target nutrient. For each category, six packages were designed using a 3 × 2 experimental design with the following variables: product version (regular, nutrient-reduced and nutrient-free) and brand (market leader and non-market leader). A total 306 Uruguayan participants completed a choice experiment with 18 choice sets. Reformulated products without nutritional warnings were preferred by participants compared to regular products with nutritional warnings. No apparent preference for products reformulated into nutrient-reduced or nutrient-free product versions was found, although differences depended on the product category and the specific reformulation strategy. Preference for reformulated products without nutritional warnings was more pronounced for non-market leaders. Results from the present work suggest that reformulation of foods in the context of the implementation of nutritional warnings holds potential to encourage consumers to make more healthful food choices and to cause a reduction of their intake of nutrients associated with non-communicable diseases.

Consumer accounts of favourable dietary behaviour change and comparison with official dietary guidelines.

OBJECTIVE: The current study aimed to assess Uruguayan consumers' accounts of their own need to change their dietary patterns, their intended changes and the barriers related to doing so, and to compare the intentions and barriers with the recommendations of the national dietary guidelines. DESIGN: An online survey with 2381 Uruguayan employed adults, aged between 18 and 65 years, 65 % females, was conducted. Participants had to answer two open-ended questions related to changes they could make in the foods they eat and/or the way in which they eat to improve the quality of their diet and the reasons why they had not implemented those changes yet. Content analysis using inductive coding by two researchers was used to analyse the responses. RESULTS: Consumers mainly intended to change consumption of types of foods, particularly eating more fruits, vegetables and legumes and consuming less flour, but also intended to alter their eating patterns. Lack of time and the fact that healthy foods are perceived as being more expensive than unhealthy foods were major barriers to behaviour change. Some of the recommendations of the dietary guidelines, particularly those related to enjoying cooking and meals and engaging in it as a social activity, were not represented in consumer accounts. CONCLUSIONS: Accompanying policies to the dietary guidelines need to underline the importance of changes in dietary patterns, including greater enjoyment and sharing food preparation and meals in the company with others, address misconceptions about flour, and provide concrete, consumer-derived recommendations on how to enact the guidelines.