Fifteen-year trends in the prevalence of barriers to healthy eating in a high-income country

Abstract

Despite increasing levels of education and income in the Swiss population over time and greater food diversity due to globalization, adherence to dietary guidelines has remained persistently low. This may be because of barriers to healthy eating hampering adherence, but whether these barriers have evolved in prevalence over time has never been assessed, to our knowledge. We assessed 15-y trends in the prevalence of self-reported barriers to healthy eating in Switzerland overall and according to sex, age, education, and income. We used data from 4 national Swiss Health Surveys conducted between 1997 and 2012 (52,238 participants aged ≥18 y, 55% women), applying multivariable-adjusted logistic regression models to assess trends in prevalence of 6 barriers to healthy eating (taste, price, daily habits, time, lack of willpower, and limited options). The prevalence of 3 barriers exhibited an increasing trend until 2007, followed by a decrease in 2012 (from 44% in 1997 to 50% in 2007 and then to 44% in 2012 for taste, from 40% to 52% and then to 39% for price, and from 29% to 34% and then to 32% for time; quadratic -trend< 0.0001). Limited options decreased slightly until 2007 (35-33%) and then sharply by 2012 (18%) (linear -trend< 0.0001). Daily habits remained relatively stable across time from 42% in 1997 to 38% in 2012 (linear -trend< 0.0001). Conversely, lack of willpower decreased steadily over time from 26% in 1997 to 21% in 2012 (linear -trend< 0.0001). Trends were similar for all barriers irrespective of sex, age, education, and income. Between 1997 and 2012, barriers to healthy eating remained highly prevalent (≥20%) in the Swiss population and evolved similarly irrespective of age, sex, education, and income.

Twenty-four-year trends and determinants of change in compliance with Swiss dietary guidelines

“…Generational analysis was conducted using [35][36][37][38][39][40][41][42][43][44] and [45][46][47][48][49][50][51][52][53][54] age groups in 1993. The [35][36][37][38][39][40][41][42][43][44] age group in 1993 corresponded to the [40][41][42][43][44][45][46][47][48][49] age group five years later (1998) and to the [45][46][47][48][49][50][51][52][53][54] age group in 2003. To assess 20year trends, only age groups [35][36]…”

“…The [35][36][37][38][39][40][41][42][43][44] age group in 1993 corresponded to the [40][41][42][43][44][45][46][47][48][49] age group five years later (1998) and to the [45][46][47][48][49][50][51][52][53][54] age group in 2003. To assess 20year trends, only age groups [35][36][37][38][39][40][41][42][43][44] and [45][46][47][48][49][50][51][52][53][54] The impact of the guidelines on compliance was assessed by comparing compliance levels in the 5-year period before and after the issuing of the guidelines. Firstly, we compared period 1993-1997 with period 1998-2002, and period 2006-2010 ...…”

“…The results indicate that compliance with at least three guidelines was rather low and remained so over the 24-year study period. Conversely, an increase in compliance was found for generations aged [35][36][37][38][39][40][41][42][43][44] and [45][46][47][48][49][50][51][52][53][54] in 1993.…”

“…The overall results are presented in Supplemental Table S3 (including fried fish) and Supplemental Table S4 (excluding fried fish). In non-adjusted analysis, compliance (including fried fish) increased in women and decreased in participants with educational level below university; after multivariate adjustment, compliance increased in the [55-64] age group and decreased in [35][36][37][38][39][40][41][42][43][44] and [45][46][47][48][49][50][51][52][53][54] age groups (Table 2 and Supplemental Table S3). When fried fish was excluded, compliance increased in the whole sample and in men, the [55-64] age group and in participants with educational level below university; after multivariate adjustment, compliance increased only in the [55-64] age group (Table 3 and Supplemental Table S4).…”

“…Several factors might explain this improvement. First, income tends to increase with age, allowing subjects to buy healthier (and usually more expensive) foods; indeed, a previous study has shown that price was one of the main barriers for healthy eating, and that its prevalence decreased with age [41,42]. Second, because of the high cost of food in Switzerland, people living in Geneva are increasingly buying their foods in nearby France, which might also increase the accessibility to healthier foods [32].…”