Implementing and sustaining dietary change in the context of social relationships.

BACKGROUND: Changing to healthier dietary habits is quite difficult to implement and even more difficult to sustain. As the majority of people have some or all their meals with others, it is likely that their social relationships influence the dietary change process and its sustainability. Thus, the aim of this research was to explore and describe experiences of dietary change and its sustainability in the context of an individual's social relationships. METHODS: Semi-structured interviews were conducted individually with fourteen individuals who had previously been participants in a 3-month dietary intervention study using a Mediterranean diet. Thematic analysis was used on verbatim transcripts of the interviews. RESULTS: Social relationships were the main barrier to sustainability - in particular social relationships within the household where various coping strategies were needed on an everyday basis. Social relationships outside the household were also difficult to manage as dietary change challenged existing traditions and norms of what to eat. The changer was thereby forced to risk social disapproval or to deviate from the diet. CONCLUSIONS: Social relationships within and outside the household complicated the accomplishment of healthy dietary changes. Hence, it is important to acknowledge the social context of the changer when dietary change is to be implemented.

Food that makes you different: the stigma experienced by adolescents with celiac disease.

For adolescents with celiac disease (CD), a gluten-free diet (GFD) is crucial for health, but compliance is problematic and noncompliance is common even among those aware of the risks. To better understand their lives with the disease, Swedish CD adolescents were invited to take part in focus group discussions. Data were analyzed for recurrent stigma-related themes across the groups. Adolescents described an awareness of being different from others that was produced by meal appearance and the poor availability of gluten-free food. The GFD often required discussions and special requests, so eating in public had the effect of making an invisible condition visible, and thereby creating a context for felt or enacted stigma. Maintaining invisibility avoided negative consequences of stigma, and other strategies were used to reduce the costs of visibility. The results of the study show that the GFD can produce stigma experiences in adolescence, and that dietary compliance (or lack thereof) can be understood in terms of dealing with GFD concealment and disclosure.

Observed dietary intake in adults with intellectual disability living in the community.

BACKGROUND: Knowledge is lacking about dietary habits among people with intellectual disability (ID) living in community residences under new living conditions. OBJECTIVE: To describe the dietary habits of individuals with ID living in community residences, focusing on intake of food, energy and nutrients as well as meal patterns. DESIGN: Assisted food records and physical activity records over a 3-day observation period for 32 subjects. RESULTS: Great variation was observed in daily energy intake (4.9-14 MJ) dispersed across several meals, with on average 26% of the energy coming from in-between-meal consumption. Main energy sources were milk products, bread, meat products, buns and cakes. The daily intake of fruit and vegetables (320+/-221 g) as well as dietary fiber (21+/-9.6 g) was generally low. For four vitamins and two minerals, 19-34% of subjects showed an intake below average requirement (AR). The physical activity level (PAL) was low for all individuals (1.4+/-0.1). CONCLUSION: A regular meal pattern with a relatively high proportion of energy from in-between-meal eating occasions and a low intake of especially fruits were typical of this group of people with ID. However, the total intake of energy and other food items varied a great deal between individuals. Thus, every adult with ID has to be treated as an individual with specific needs. A need for more knowledge about food in general and particularly how fruit and vegetables could be included in cooking as well as encouraged to be eaten as in-between-meals seems imperative in the new living conditions for adults with ID.