What Are the Family Barriers and Facilitators of Healthy Eating Habits Among Adolescents?

Background:

Healthy lifestyle is a key preventive approach to combat the rising prevalence of non-communicable diseases (NCD) worldwide], among which diet is highlighted as a modifiable risk factor of the most common NCD, namely hypertension, diabetes mellitus and coronary heart disease. Adolescence is a transitioning stage from parent-dependence to increasing autonomy in behavior including healthy or risky behavior. The dietary habit established in this period has high tendency to continue to adulthood.

Many national dietary recommendations were established to promote quality diet in order to prevent NCD in the population. They commonly cover starchy foods, vegetables and fruits, protein food, dairy, fats/oils and sugars/sweets. Some guidelines are more generic on certain food groups or overall diet, such as "Eat plenty of cereals, preferably wholegrain, and potatoes" and "Eat foods from each food group every day to have a complete diet". Others provide quantified suggestion, for example, "Consume three or more servings of vegetables and at least two servings of fruit per day" and "Less than 5 g of salt per day and use iodized salt". However, the adherence rate to these recommendations remains low in most other populations, with at least 60% of general population having insufficient intake of fruit and vegetables and overconsumption of added sugar and sodium. The Hong Kong Population Health Survey 2014/15 found that 94.4% of local residents aged 15 or above consumed less than the recommended 5 servings of fruit and vegetables each day, and 21.5% had eaten snacks with high salt content at least once a week in the past one month.

Many studies have explored the contributing factors of eating habits among adolescents. Based on Health Belief Model, they can be categorized into A) socio-psychological variables including familial factors and peer influence; B) cue to action by media, home and school environment; C) perceived benefits on personal health; and D) perceived barriers on personal preference towards food, logistic and lack of motivation. Family factors affect adolescents' eating pattern in multiple dimensions, including parental modeling, home food environment, education on healthy eating and mealtime structure.

The Innocenti Framework on Food System for Children and Adolescents explains the family role in adolescents' diet. The framework was developed by UNICEF in 2018 to address the direct and underlying factors, drivers, and dynamics between food, people, and the planet. It comprises four determinants, namely Food Supply Chain, External Food Environments, Personal Food Environments, and Behaviors of Caregivers, Children and Adolescents. The former two determinants outline the structural factors of the system, such as taxation, advertisement on media, and food availability in the market. The latter two look into the social and personal variables, which comprise individual and household factors. Family factors including accessibility, affordability and convenience of healthy food are personal environment determinants; intra-household dynamics (e.g. care practices, control on household expenses), food preparation, socioeconomic characteristics and eating patterns are behavioral determinants in the family. The framework emphasizes the dynamics between the determinants and diets of children and adolescents. For instance, food price and availability in the market contribute to personal food environments, which is also influenced by personal desirability and food preparation skill. Parental behaviors become a buffer between food environments and children's diets.