Chapter 3 Everyone Has a Role in Supporting Healthy Eating Patterns

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Meeting People Where They Are: Contextual Factors and Healthy Eating Patterns

As previously described, the Social-Ecological Model provides a framework for how individuals make food and physical activity choices (where, what, when, why, and how much) each day. Understanding individual choices and motivators and the context that affects them can help professionals identify which strategies are most likely to be effective to promote healthy choices aligned with the Dietary Guidelines.

The scientific literature has described a number of specific circumstances that can limit an individual’s or family’s capacity to choose a healthy diet. These contextual factors—food access, household food insecurity, and acculturation—are particularly important for millions of individuals living in the United States. As appropriate, professionals can consider these critical factors when developing strategies and providing education to enhance interventions.

Food Access

Having access to healthy, safe,^[2] and affordable food choices is crucial for an individual to achieve a healthy eating pattern. Food access is influenced by diverse factors, including proximity to food retail outlets (e.g., distance to a store or the number of stores in an area), individual resources (e.g., income or personal transportation), and neighborhood-level resources (e.g., average income of the neighborhood and availability of public transportation). Race/ethnicity, socioeconomic status, geographic location, and the presence of a disability also may affect an individual’s ability to access foods to support healthy eating patterns.

Innovative approaches are emerging to improve food access within communities. These include creating financing programs to incentivize grocery store development; increasing the availability of foods to support healthy eating patterns in retail outlets, including corner stores, bodegas, farmers markets, mobile markets, shelters, food banks, and community gardens/cooperatives; and creating new pathways for wholesale distribution through food hubs.

Food access is important in all settings where people make choices. Improving food access in settings, such as schools, worksites, early care and education programs, and food retail, may include changing organizational policies to improve the availability and provision of healthy food choices, developing or updating nutrition standards for food service operations, and educating customers about how to identify healthy choices, such as through point-of-purchase information. Changes to food options within a setting should not be done in isolation but with consideration of the overall mix of foods provided (e.g., in cafeterias, at meetings, in vending machines, concession stands and elsewhere).

To help everyone make choices that align with the Dietary Guidelines, professionals are encouraged to identify ways to improve food access. Ultimately, individual choices will be enhanced when sectors and settings ensure the accessibility of safe, affordable, and healthy food choices.

Household Food Insecurity

In the United States, about 48 million individuals live in households that experience food insecurity, which occurs when access to nutritionally adequate and safe food is limited or uncertain. Food insecurity can be temporary or persist over time. Living with food insecurity challenges a household’s ability to obtain food and make healthy choices and can exacerbate stress and chronic disease risk. Government and nongovernment nutrition assistance programs play an essential role in providing food and educational resources to help participants make healthy food choices within their budget. Food insecurity persists in the United States, and maintaining current programs, networks, and partnerships is crucial in addressing the problem. Exploring innovative new strategies could provide opportunities to reach more individuals, families, and households experiencing food insecurity. For example, sectors can create networks and partnerships to deliver food and other resources to reach people who are in need and when community services are scarce. Individuals who are supported in this way are better able to obtain and make healthy food choices that align with the Dietary Guidelines.

Acculturation

The United States continues to evolve as a nation of individuals and families who emigrate from other countries. Individuals who come to this country may adopt the attitudes, values, customs, beliefs, and behaviors of a new culture as well as its dietary habits. Healthy eating patterns are designed to be flexible in order to accommodate traditional and cultural foods. Individuals are encouraged to retain the healthy aspects of their eating and physical activity patterns and avoid adopting behaviors that are less healthy. Professionals can help individuals or population groups by recognizing cultural diversity and developing programs and materials that are responsive and appropriate to their belief systems, lifestyles and practices, traditions, and other needs.