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Barriers preventing sustainable dietary changes and how to overcome them

Posted on 31st October 2020

Whether you have been told to follow a specific diet for a health condition, are dieting to lose weight or want to eat healthier for longevity and vitality, it’s always a relevant topic in the majority of the population. Unless you are in the minority and have never had to worry about your health or waistline.

Working as a Nutritionist for seven years, I decided to devote the last few years researching this fascinating topic of sustainable behaviour change. My clinical research has taught me that dietary change is often short lived and I wanted to find out why that was. This research (which is ongoing) led me to come up with two main emerging themes; namely barriers and facilitators. Sub-themes which can be either barriers or facilitator included cost, social relations, self-care and patient-practitioner relationship.

Barriers and Facilitators

 
CostCost of food was a major concern amongst participants in the study by Hammarstrom (2014) and Madden (2016) and those in the Hammarstrom (2014) study for whom budget was not a problem, felt inspired to try a new diet.  
Social relationsPerceived as a barrier, due to lack of support from their family/friends (Hammerstrom, 2014; Malm, 2017). Barriers such as cooking for family, having to relearn cooking and deal with refusal from family members to eat new food (Ahlgren, 2015). However, they did not want to be restricted because the sense of belonging when eating family meals had a positive impact on their quality of life (Ahlgren, 2015). A facilitator for some woman continuing, in the Hammerstrom (2014) study was supportive friends and family.  
Self-careBeing able to take control of their health through diet was a facilitator identified by Lindberg (2014). Self-determination was another facilitator identified by Hammarstrom (2014). Barriers included falling back into old habits (Hammarstrom, 2014) and lack of self-control (Hammarstrom, 2014; Ahlgren, 2015).  
Patient-practitioner relationshipPaternalistic communication and indifferent care by dieticians made participants feel disempowered, whereas an empathetic dietician made patients feel positive regarding their lifestyle (Morris, 2017). Madden (2016) found that a flexible and personalised approach, including confidence in the practitioner were facilitators (Madden, 2016). The importance of active support was a key theme in the systematic review by Murray (2013), to facilitate behavioural change. Sussman (2001) concludes that the role of the dietician is not to impose change, but to support patients in their process of individual adapting to change.  

The findings acknowledge the importance of a practitioner who plays a supportive and empathetic role, while providing a personalised approach; including considering each person’s unique circumstances e.g. budget for food, support from family and friends and the individuals’ attitude and belief in their ability to follow a nutrition protocol.

So how to we overcome these barriers and facilitate change within ourselves, our families, communities and families? I wish I had all the answers but these are my thoughts.

  1. We need to change our mindsets about how we look at food.
  2. We need to stop seeing eating as being “good” or “bad”
  3. We need to find practical ways to incorporate healthy eating into our homes and acknowledge the fundamental role healthy eating has on improving our health and society.
  4. We need to make the media and organisations accountable for their engagement with us and the message they portray which drives consumer demand.
  5. We need to provide primary and secondary support to those in need of dietary intervention, which is long-term and empathetic to people’s unique struggles.
  6. We need to stop promoting fad diets and celebrate our unique shapes and sizes, while supporting a healthy eating and lifestyle.

References

Ahlgren, C., Hammarström, A., Sandberg, S., Lindahl, B., Olsson, T., Larsson, C., & Fjellman-Wiklund, A. (2016). Engagement in New Dietary Habits—Obese Women’s Experiences from Participating in a 2-Year Diet Intervention. International Journal of Behavioral Medicine, 23(1), 84–93. https://doi.org/10.1007/s12529-015-9495-x

Lee, S., Stetten, N., & Anton, S. (2018). Patient perspectives on the treatment for Hashimoto’s thyroiditis: a qualitative analysis. Health and Primary Care, 2(3). https://doi.org/10.15761/hpc.1000141

Lindberg, A., Fossum, B., Karlen, P., & Oxelmark, L. (2014). Experiences of complementary and alternative medicine in patients with inflammatory bowel disease – a qualitative study. BMC Complementary and Alternative Medicine, 14(1). https://doi.org/10.1186/1472-6882-14-407

Madden, A. M., Riordan, A. M., & Knowles, L. (2016). Outcomes in coeliac disease: a qualitative exploration of patients’ views on what they want to achieve when seeing a dietitian. Journal of Human Nutrition and Dietetics, 29(5), 607–616. https://doi.org/10.1111/jhn.12378

Malm, K., Bremander, A., Arvidsson, B., Andersson, M. L. E., Bergman, S., & Larsson, I. (2016). The influence of lifestyle habits on quality of life in patients with established rheumatoid arthritis – A constant balancing between ideality and reality. International Journal of Qualitative Studies on Health and Well-Being, 11. https://doi.org/10.3402/qhw.v11.30534

Murray, J., Fenton, G., Honey, S., Bara, A. C., Hill, K. M., & House, A. (2013). A qualitative synthesis of factors influencing maintenance of lifestyle behaviour change in individuals with high cardiovascular risk. BMC Cardiovascular Disorders, 13. https://doi.org/10.1186/1471-2261-13-48

Sussmann, K. (2001). Patients’ experiences of a dialysis diet and their implications for the role of the dietitian. Journal of Renal Nutrition, 11(3), 172–177. https://doi.org/10.1053/jren.2001.24365