Elsevier

Appetite

Volume 153, 1 October 2020, 104740
Appetite

“Do you think adolescents’ food intake is satisfactory?” – Views of Indian parents and teachers

https://doi.org/10.1016/j.appet.2020.104740Get rights and content

Abstract

Adolescents develop food habits that affect both their present and future health. Underpinned by the stakeholder theory, this study was designed to explore the perspective of parents and nutrition educators regarding urban Indian adolescents’ food habits. Thirty-two educators and 280 parents from five independent, English-speaking, secondary schools in Kolkata, India completed a paper-based instrument consisting of both closed and open-ended measures. Qualitative data were subjected to thematic analysis informed by the Template Analysis Technique. Descriptive and cross-tabulation analyses were employed to assess quantitative data. Three quarters (75%) of the respondents were dissatisfied with the ubiquitous consumption of energy-dense, nutrient-poor foods and sugar-sweetened beverages as well as the low intakes of healthy foods like fruits and vegetables among urban Indian adolescents. Six reasons were advanced for such unhealthy consumption including i) Proliferation of fast food retail outlets; ii) Hyper-palatability of fast food; iii) Marketing of fast food on electronic and social media; iv) Diminished household cooking practices; v) Lack of food knowledge; vi) Tendency to seek peer group acceptance. Both parents and educators suggested some healthy eating strategies aimed at improving the food and nutrition situation in Indian secondary schools to foster healthy eating among pupils. These included: i) Restrictions on the sale of unhealthy foods in school canteens; ii) Increased availability of attractive and palatable nutritious foods; iii) Discussion of the advantages of consuming healthy foods and inclusion of food preparation techniques in the school curriculum; iv) Home Economics coursework to be made mandatory for students. The findings suggest that Indian parents and teachers are likely to support changes to the food and nutrition curricula and to school food provision to foster healthy eating among adolescents.

Introduction

Over the last decade, India has witnessed a burgeoning prevalence of adolescent overweight and obesity (Ranjani et al., 2016). Overweight and obesity are identified as potential risk factors for the rising burden of non-communicable diseases including cardiovascular disease, hypertension, diabetes, and certain cancers (Lobstein et al., 2015). These health complications demonstrate that overweight and obesity prevention should be an urgent priority for the Indian Government and health agencies (Shetty, 2013).

Unhealthy food practices have largely contributed to the emerging obesity and the associated disease burden (National Institute of Nutrition, 2010). In the light of globalisation and urbanisation, the customary Indian dietary pattern has undergone a major transformation i.e. replacement of a whole-grain diet with ‘Western’ diets rich in saturated fat, refined cereals, sugar, and deficient in dietary fibre (Pingali, 2007). This dietary shift is predominant in urban Indian populations (National Institute of Nutrition, 2010) including adolescents (Rathi, Riddell, & Worsley, 2017b). In addition, many Indian adolescents frequently skip meals, particularly breakfast (Mithra et al., 2018) and snack on fast food and sugar-sweetened beverages (Gupta, Kapil, & Singh, 2018, Rathi et al., 2018e). This evolving dietary context presents an opportunity to explore the factors that are triggering the consumption of unhealthy foods and beverages among young people. The understanding of these causative factors will help to lay the foundation for future health and nutrition promotion programs aimed at improving the eating habits of young people.

Globally, school-based nutrition and health promotion programmes have been popular in encouraging healthy eating among young people (Worsley, 2008). In contrast, Indian schools, have often been criticized for inculcating unhealthy eating habits in students (Mehan, Munshi, Surabhi, Bhatt, & Kantharia, 2012; Rathi et al., 2016, 2017c). Therefore, the current investigation aimed to understand the views of parents and teachers regarding Indian adolescents’ dietary intake and their recommendations for schools in overcoming challenges associated with healthy eating. Both parents and teachers have been identified as key stakeholders in the education system and hence their views are vital for the development of effective school-based healthy eating interventions (Chaleunsouk et al., 2014).

Section snippets

Methods

The methodology for this study i.e. ‘School Food Landscape Survey’ has been described in detail previously (Rathi et al., 2018a, 2018c, 2019). A notable feature of this survey was the inclusion of the dietary data emerging from the Dietary and Lifestyle Survey (Rathi et al., 2017b) in its instrument. This allowed parents and teachers to comment on the current state of adolescents' food habits.

Response rate and demographics

In total, 312 respondents (280 parents and 32 teachers) completed the survey yielding an overall response rate of 91%. The majority of the sample were women (69%). The mean age was 41.9 years (SD 4.5 years). Hinduism was the most popular religion (80%) and nine out of ten respondents had attained a university degree. With regards to occupation, approximately half of the parents identified themselves as homemakers (49%).

Quantitative findings

The respondents reported mixed views about adolescents' dietary intake. Half

Discussion

The present survey explored parents' and teachers' views of Indian adolescents' dietary intake and the factors that may influence adolescents' food intake. The quantitative findings suggest that several stakeholders were not much aware of the healthy and unhealthy intakes in their adolescents, while, a consensus was that adolescents’ food intake was not satisfactory and detrimental to future health. The qualitative findings suggest that increased availability and palatability of fast food,

Authors contributions

N.R., L.R. and A.W. conceived the study and its original design. N.R. drafted the initial form and all revisions of this paper. N.R. collected and analysed the data. N.R., L.R., and A.W. reviewed and approved the final manuscript.

Funding statement

NR was supported through a Victoria India Doctoral Scholarship; and internal funding was provided by the School of Exercise and Nutrition Sciences, Deakin University.

Ethical statement

Ethical approval for this study was obtained from Deakin University's Health Ethics Advisory Group (HEAH-H 127_2016). The procedures performed were in accordance with the ethical standards of the committee. Written informed consent was obtained from all respondents before commencement of the study.

Declaration of competing interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this research article.

Acknowledgements

The authors thank the school principals, teachers, and parents who generously took part in this study.

References (61)

  • R. Brugha et al.

    Stakeholder analysis: A review

    Health Policy and Planning

    (2000)
  • L. Chaleunsouk et al.

    Ontario schools' readiness for school food and beverage policy implementation

    Journal of Educational Policies and Current Practices

    (2014)
  • H.T. Chen et al.

    Formal theory versus stakeholder theory: New insights from a tobacco-focused prevention program evaluation

    Ameriacn Journal of Evaluation

    (2012)
  • D. Coitinho et al.

    What Brazil is doing to promote healthy diets and active lifestyles

    Public Health Nutrition

    (2002)
  • J.W. Creswell

    Qualitative inquiry and research design: Choosing among five approaches

    (2013)
  • M. Das Gupta et al.

    Why is son preference so persistent in east and south Asia? A cross-country study of China, India and the Republic of Korea

    Journal of Development Studies

    (2003)
  • H. Ensaff et al.

    Food choice architecture: An intervention in a secondary school and its impact on students' plant-based food choices

    Nutrients

    (2015)
  • D. Goel et al.

    Teacher education scenario in India: Current problems & concerns

    MIER Journal of Educational Studies, Trends & Practices

    (2016)
  • Government of India

    Population by religious communities of census 2011

  • A. Gupta et al.

    Consumption of junk foods by school-aged children in rural Himachal Pradesh, India

    Indian Journal of Public Health

    (2018)
  • D. Hersch et al.

    The impact of cooking classes on food-related preferences, attitudes, and behaviors of school-aged children: A systematic review of the evidence 2003–2014

    Preventing Chronic Disease

    (2014)
  • S. Jayachandran et al.

    Why do mothers breastfeed girls less than boys? Evidence and implications for child health in India

    Quarterly Journal of Economics

    (2011)
  • N. Joshi et al.

    A study of the prevalence of childhood obesity and overweight in private and government schools of Meerut city

    International Journal of Community Medicine and Public Health

    (2019)
  • J.S. Kaushik et al.

    Fast food consumption in children

    Indian Pediatrics

    (2011)
  • N. King

    Using templates in the thematic analysis of text

  • G. Kok et al.

    Influencing organizations to promote health: Applying stakeholder theory

    Health Education & Behavior

    (2015)
  • J. Kumar et al.

    Identifying barriers, perceptions and motivations related to healthy eating and physical activity among 6th to 8th grade, rural, limited-resource adolescents

    Health Education

    (2016)
  • G. Lancaster et al.

    Household expenditure patterns and gender bias: Evidence from selected Indian states

    Oxford Development Studies

    (2008)
  • H.A. Majabadi et al.

    Factors influencing fast-food consumption among adolescents in tehran: A qualitative study

    Iranian Red Crescent Medical Journal

    (2016)
  • J.F. Marques et al.

    The application of interrater reliability as a solidification instrument in a phenomenological study

    Qualitative Report

    (2005)
  • Cited by (13)

    • Transformation in culinary behaviour during the COVID-19 pandemic: In-depth interviews with food gatekeepers in urban India

      2022, Appetite
      Citation Excerpt :

      The views of household food gatekeepers are integral to this study as they have the biggest influence on the food behaviours of their family members that are related to food preparation, health, and food acquisition (Burton et al., 2017; Reid et al., 2009). In India, women have culturally served as nutritional gatekeepers at the household level (Rathi et al., 2017, 2020). In addition, this exploratory study aimed to identify food preparation behaviours that could be adopted among Indian families for healthier food consumption (e.g. greater intake of nutrient dense, low energy density foods; reduced intake of energy dense, nutrient poor foods) post COVID-19 and prepare for future disruptions.

    View all citing articles on Scopus
    1

    This is N.R.‘s current affiliation. She is working as a Post Doctoral Fellow.

    View full text