Sweden: Women in this work were more likely than men to avoid eating gluten, red meat, white flour and food additives due to perceived unhealthiness, and reported more diet and health related anxiety

Gender differences in perceived food healthiness and food avoidance in a Swedish population-based survey: a cross sectional study. Linnea Bärebring, Maria Palmqvist, Anna Winkvist & Hanna Augustin. Nutrition Journal volume 19, Article number: 140, Dec 29 2020. https://link.springer.com/article/10.1186/s12937-020-00659-0

Rolf Degen's take: https://twitter.com/DegenRolf/status/1345253441212477440

Abstract

Background: The aim of this work was to study potential gender differences in perceived food healthiness and food avoidance in a population-representative sample of the Swedish adult population.

Methods: A questionnaire regarding diet and health was posted to 2000 randomly selected residents in Sweden, aged 20–65 years. Questions were posed regarding which foods or food components the participants avoided due to perceived unhealthiness and how healthy they believed the food items to be. The pre-specified food components included sugar, carbohydrate, gluten, lactose, dairy, fat, saturated fat, red meat, white flour, salt, alcohol and food additives (specifically glutamate, sweetening, preservative and coloring agents). Chi square tests were used to study differences in perceived food healthiness and food avoidance depending on gender.

Results: Around 50% reported avoidance of sugar (51.6%) and sweeting agents (45.2%), whereas fewer reported avoidance of saturated fat (16.8%) and salt (10.6%). Women were more likely than men to avoid gluten (AOR [95% CI] 2.84 [1.33–6.05]), red meat (3.29 [1.86–5.80]), white flour (2.64 [1.65–4.21]), preservatives (1.7 [1.07–2.70]) and coloring agents (2.10 [1.29–3.41]) due to perceived unhealthiness. Gender differences were also apparent in perceived healthiness of sugar, gluten, dairy, red meat, white flour, alcohol and food additives, where women tended to be more negative than men in their attitudes. Women more often said to read new findings in media about diet (16% vs 9%, p = 0.029) and prioritize a healthy lifestyle (35% vs 25%, p = 0.015). More than a third of both women and men reported worrying over the healthiness of their diet, and a higher proportion of women than men (18% vs 11%, p = 0.015) agreed with the statement that they were often anxious over having an unhealthy diet.

Conclusions: Women in this population-based study of residents in Sweden were more likely than men to avoid eating gluten, red meat, white flour and food additives due to perceived unhealthiness, and reported more diet and health related anxiety. Future research to identify effective ways of promoting healthy eating for both women and men, while minimizing diet-health related anxiety, is highly warranted.

Discussion

The results of this study show that there are gender differences in both perceived food healthiness and in food avoidance in Sweden. Overall, women reported more negative perceptions on the healthiness of sugar, gluten, dairy, red meat, white flour, alcohol and food additives. In addition, women were more likely to avoid gluten, red meat, white flour and food additives. Women also reported more anxiety related to food and health.

We found that there are gender differences in perceived healthiness of food that impacts dietary behavior. Previous studies show that women focus on nutritional value of food [10] and prioritize healthy eating [7] more so than do men. We found that the foods or food components most commonly viewed as “very unhealthy” and most commonly avoided were sugar, food additives, alcohol, saturated fat and white flour. This is in line with previous findings that women perceive sweet foods as less healthy [11] and avoid consumption of high fat foods to a higher extent [7], compared to men. A Swedish national survey from 2016 showed that women perceive the risk of falling ill through harmful substances such as chemicals in their diet, as higher than men [12]. This might, at least in part, explain why women had more negative views on food additives such as sweetening, coloring and conserving agents. Though all approved food additives are considered safe for human consumption, our findings suggest that there is a widespread concern of the health effects of these substances.

It is noteworthy that both women and men (but women more so than men) had more negative views on food additives than of established dietary risk factors such as salt, saturated fat and alcohol. This is possibly due to the recent year’s trend toward eating “clean” [13], which refers to consumption of unprocessed, whole foods and sometimes the elimination of entire food groups (e.g. dairy, sugar or gluten) [14]. Though perceived as healthy by many [14], “clean eating” does not guarantee a high quality diet [15] and could be associated with disordered eating [16]. As women’s dietary behavior to a greater extent than men’s seems impacted by perceived healthiness and is more likely to change over time [17] –dietary fads might have a greater impact on women’s diet. Previous findings from the current research project showed that women were indeed more likely than men to keep a specific diet and attempt to lose weight [9]. This could also be a reflection of women’s greater tendency to be impacted by dietary fads and trends. The specific diet, or foods or food components that are avoided likely differs over time, but this needs verification in longitudinal studies.

The observed gender differences in the current and previous studies might have significant implications for public health. Findings are consistent that women are more health conscious than men –both in general [8] and in specific regards to their diet [7]. This might have parallel effects, where women eat healthier than men but also have more body shape concerns and diet-related anxiety. Perceived diet-related risks are assessed by both emotional and cognitive considerations, among both women and men [18]. Thereby, simply providing more information on diet and health is unlikely to eliminate gender differences in food perception and avoidance. More research is needed to identify effective ways of promoting healthy eating for both women and men, while minimizing diet-health related anxiety.

Strengths and limitation

Strengths of the current study include the relatively high response rate (28%) for this kind of study, and that the study sample is deemed population-representative. We have previously concluded that the sample seems representative of the general Swedish population in regards to prevalence of overweight and income, whereas the education level was slightly higher than the general Swedish population [9]. The proportions of women and men in the study are 55 and 45%, which indicated that women are slightly overrepresented (as the national gender distribution is 50% women, 50% men). Thus, there are small differences in sociodemographic data in this study sample, compared to the general population. The study results are thereby likely generalizable to the Swedish population in the current age span. Limitations include a lack of detailed dietary intake data to verify that reported food avoidance was also reflected in actual diet. In addition, a number of statistical tests were performed on several variables in this paper, and p-values should thereby be interpreted with caution. An additional limitation is the pre-specified answers that may have restricted the range of possible responses to the questions. Even though free text options were available, these were not frequently used. Future studies should consider combining quantitative and qualitative approaches to provide further clarity to the motivations for women’s more frequent food avoidance.