2. social and financial considerations, sensory perception and ease

2. BarriersSince the 1980s, there has been an alarming increase in the number of individuals reported as obese. However, this epidemic has implications not only related to health, but also causes additional economic and social tension on community, governmental and global levels (Munt, Partridge, & Allman-Farinelli, 2017). Therefore, it is essential to understand and combat the factors that lead to this negative shift in the weight management of the modern population. The most prominent determinant of the obesogenic trend is a poor eating behavior (Reed et al., 2016). The paradox comes from the fact that, in general, the population is aware of the customs and types of food that lead to a healthy diet, as well as their importance for a vigorous long-term health status, yet do not follow them (Chambers, Lobb, Butler, & Traill, 2008). When considering the several inklings of eating patterns, the impact of various factors on our decisions of food choices reveals a complex relationship.

Several drivers act as barriers to an adequate diet, and while a number of them are embedded in socio-economic or biological conditions, others can be appropriately managed as individual decision-making components. For example, Falk et al., 1996 already discovered 2 decades ago the fact that choice-influencing components such as social and financial considerations, sensory perception and ease of access or preparation were universal to adults, along with individual life experiences or events (Garaulet et al.

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, 2012; Winter Falk, Bisogni, & Sobal, 1996). While some barriers are still true throughout adulthood, particular age-groups are showing a special disparity in the quality of diet, the most prominent being observed in young adults (Grech et al., 2017). For the past 20 years many studies reported how demographic, economic, societal and even anthropologic variables are considered key to understand the obstacles to obtain quality food as well as the inclination to its intake (Flegal, Kruszon-Moran, Carroll, Fryar, & Ogden, 2016; Kearney & McElhone, 1999; Reed et al., 2016). While the economic factors are seen as critical, socio-demographic tendencies aligned with psychological trends seem to play a significant role in the perception of food properties. This relationship might help, working as an enabler of healthy diet consumption or it can be diminished by the special trends that young population presents nowadays.

In order to understand the behavior of these subjects, one must first consider the factors that make this age cohort unique in their diet choices and health behavior.Young adulthood stands at a temporal crossroads, under the presence of continuous change and flux. Leaving home and enrolling for college or transitioning to employment are factors that rapidly lead these individuals towards a more independent life with more autonomous choices regarding diet (Pelletier & Laska, 2012). The majority of young adults studies showed worrisome results, as 4-yearand 2 year-college students show excess weight gain, increasing their risk for obesity and other related diseases (Laska, Pasch, Lust, Story, & Ehlinger, 2011; T.

F. Nelson, Gortmaker, Subramanian, Cheung, & Wechsler, 2007). While moving away from home, another key-player in the determination of their eating patterns is represented by the stability of employment and residency (M. C. Nelson, Story, Larson, Neumark-Sztainer, & Lytle, 2008). Additionally, the potential cohabitation can lead to a shift in the perception and motivation for healthy eating.

Changing potential norms is more pronounced in young adulthood, as the social groups are also transitioning (Munt et al., 2017). With the increasing autonomy they experience, young adults also face the challenges of financial independence for the first time, which was determined by many studies as a key-player for food choice decisions (Chambers et al., 2008; Garaulet et al., 2012; Reed et al.

, 2016). This is also a particularly special age due to the increased stress, whether it is related to academic or financial stability, but also due to the need for perfecting time management skills (Pelletier & Laska, 2012). In the end, all these factors shape the young adult’s individual opinions and attitudes regarding healthy diets and physical activity, establishing self-identity (Munt et al.

, 2017). This age is especially important as lifelong behaviors can be established under the influence of self-confidence and ability to maintain healthy diets efficiently (M. C. Nelson et al., 2008).  It is imperative to understand the aforementioned aspects, as young adulthood stands at a temporal crossroads of high importance for health behavior validation, making the prevalence of efficient interventions less probable, if the constraints experienced by these subjects are not taken into consideration.

Additionally the reasons for which young adults follow or not healthy dietary patterns have to be understood and combated as a personalized approach for this unique age group. In fact, many scoping reviews and meta-analyses tried to summarize the biggest restrictions these individuals experience and identify their barriers to healthy dietary behaviors. A scoping review from 2017 managed to compile an extensive list of key barriers identified through a large-scale literature search, targeting 34 studies from 10 developed countries conducted over the past decade They found the following: interpersonal barriers (male apathy towards following a diet, following family and friend’s example of unhealthy diets, consumption of unhealthy products in specific social contexts), food security and convenience-related barriers (time restraints and lack of skill or facilities for planning and preparing a healthy meal, perceived lower costs and a wider availability of unhealthy foods) and intrapersonal barriers (better sensorial experience after consumption of unhealthy aliments, lack of motivation to follow a healthy diet and food choice preference shift under emotional experiences) (Munt et al., 2017). As each of the mentioned barriers contributes to the dietary behavior of young adults in various extents, a discussion of them is in place. 2.1. Interpersonal barriers2.

1.1. Gender-based apathy towards diet (males)Throughout different studies conducted over the past 2 decades, studies have found a discrepancy between genders towards a healthy diet (Bauer, Yang, & Austin, 2004; Chambers et al., 2008; Wardle et al.

, 2004; Winter Falk et al., 1996), showing that males have less inclination of pursuing a healthy eating habit. This was accounted to a lower consciousness of health compared to women, men perceiving healthy diet as less important (Wardle et al., 2004). In fact male diet was shown to have higher meat consumption and larger portions (Chambers et al., 2008). The lower interest in following healthy dietary guidelines was stipulated to have roots in the “historical social and gender norms”, meaning that women have been more preoccupied with appearance, weight and diet in exchange as they influenced their femininity (Munt et al.

, 2017). This has direct consequence nowadays on the male apathy towards diet, as many young men try to dissociate from the feminine stigma attributed to healthy eating and become less receptive to changing their habits (Grech et al., 2017). The reluctance to health promotion, hence, translates into more obese and overweight men globally compared to women (Reed et al., 2016). This makes it imperative to combat the dissociative perception on healthy diet. A 2006 study has already suggested using strong and “bulky” physique as a masculine motivator for promoting a lower intake of calories and boosting the engagement in physical activities, leading to a lower BMI and a healthier life style (Levi, Chan, & Pence, 2006).

            2.1.2. Incentives from family and peersAs young adulthood is represented by a very independent and dynamic time, when a special emphasis is put on social interactions and self-discovery, people who exit adolescence become more susceptible to follow trends and other peers. This process is determined by the need for social inclusion and makes individuals adhere to a behavior that allows them to expand and belong to a social group. For example, the eating habits set by family or friends will translate into the individual’s choices in order to identify with a specific group and boost self-confidence.

Moreover, many young adults feel inclined to follow “situational norms” of eating fast-food when going out with friends (Munt et al., 2017). Additionally, students and young professionals drink more alcohol, when at a party for e.g.

, in order to feel accepted, which leads to an extra caloric intake (Nanney et al., 2015).Nowadays, with the uplift of social media, incentives can also travel via non-personal interactions, making young adults more susceptible to being influenced on a daily basis. The need of inclusion experienced by this age group is further stimulated through social platforms, where food is often a topic. The exposure to recipe videos, pictures of dishes, or fast-food advertisements, for e.

g., can have an effect on the formation of lasting behavior by following and replicating the trends started by others, which ultimately, lead to a sense of belonging and acceptance (Vaterlaus, Patten, Roche, & Young, 2015). Health promotion strategies need to take these aspects into consideration, as the need for inclusion is a strong factor in the decision making process related to diet. Hence, depending on the family and peer influence, young adults can choose unhealthy foods in order to feel accepted, despite the future health risk their alimentation might pose. A more approachable strategy to give students and young professionals the incentive for a better diet could be the use of social media platforms, as they have the power to influence many individuals at once and increase popularity for healthy food choices (Munt et al., 2017; Vaterlaus et al.

, 2015).  time restraints and lack of skill or facilities for planning and preparing a healthy meal, perceived lower costs and a wider availability of unhealthy foods2.2. Food security and convenience-related barriers2.2.1. Time constraintsDue to hardship that students and young professionals face at this age, managing with the stress and pressure of a new environment, whether it is university or work space, while trying to balance them with a social life, young adults often accuse the lack of time for not following a healthier diet (Chambers et al., 2008; Kearney & McElhone, 1999; Munt et al.

, 2017). The preparation of a healthy home-cooked meal requires thought and planning, which often is a heavy burden for these subjects, where the time exchanged for a healthy dish is not a profitable choice (Pelletier & Laska, 2012). Hence, young adults resort to “time-deepening” measures, such as ordering fast food or take-away, snacking instead of having main meals, eating fast and while occupied with working or watching TV (Munt et al.

, 2017). Moreover, since this age cohort is presumably not at home during the day, the preparation of a fast meal has to be ensured (e.g. pasta, semi-prepared foods) (Chambers et al., 2008).

These responses translate in the impression of saving time, but increase the consumption of foods packed with excess calories (Celnik, Gillespie, & Lean, 2012). In order to diminish the negative effect “time-deepening”, literature suggest a healthier approach to the choice of fast foods, which save time but offer a more balanced nutrition (Munt et al., 2017).   2.2.2.

Ease of access and convenienceJust like the time constraints, the ease of access to healthy food is a major component of diet choice. As it is the case with other age groups, the proximity to certain types of foods impacts the decision of young adults (Chambers et al., 2008). Studies have shown that the close presence of fast food establishments to a low-income household increased the probability of consumption of these types of foods, while higher BMI values were associated with these living areas (Munt et al., 2017).

Moreover, it was found that the greater the distance to a supermarket, the lower the likelihood of consuming vegetables and fruits. Proportionally, factors such as owning a car or other transportation means can shift the motivation of individuals (Reed et al., 2016). At the same time, the availability of small convenience stores in neighborhoods does not improve the quality of diet in young adults, suggesting the inter-dependency of the various factors acting as barriers in healthy eating. For example, the scarcity and higher price of healthy produces compared to unhealthy ones will play a detrimental role in the adult’s diet (Munt et al., 2017). Another factor that determines the convenience of eating an unhealthy diet is the overly-abundant selection of semi-prepared dishes or other fast foods present in supermarkets, often times, providing better sensorial experiences (Reed et al., 2016).

For students, an important aspect is also the scarce availability of healthy food choices in cafeterias.2.2.3. Lack of skillsThe temptation to buy processed or fast foods increases in relation to the lack of skill for preparation of healthy foods. Due to change of women’s status and a decline in the household economics, young adults do not have the chance to acquire skills necessary for planning and cooking healthy home-made meals. Studies have shown that the existence of cooking skills in subjects was inversely proportional to the consumption of unhealthy foods (Munt et al.

, 2017). Since the possibilities of learning these skills are limited elsewhere, there has been an increase in obesogenic trends, as semi-prepared and fast foods require a minimal amount of effort to prepare (Chambers et al., 2008). Moreover, acquiring food preparation skills at a rapidly transitioning period of time as young adulthood is particularly difficult, as it requires additional time and financial investment. Hence, there is an imperative need to prepare young adults with the necessary skills for preparing fast and economical meals that provide a balanced nutritional intake. Another approach to reduce the obesogenic environment pivoting around young adults is to educate them to select superior packaged or pre-prepared foods that allow for a fair time vs cost exchange (Munt et al.

, 2017).2.2.4. Financial constraintsA recurring barrier identified throughout many studies has been the perceived financial constraint related to healthy eating (Chambers et al., 2008; Grech et al., 2017; Munt et al., 2017; Reed et al.

, 2016). Coupled with the time-saving and accessible qualities of unhealthy foods, fast food and pre-prepared meals have a greater appeal to young adults, as they also offer a flavorful sensation, energy provision and satiety (Munt et al., 2017). Nevertheless, access to healthy food is a predominant evidence of the inequality in demographic and socioeconomic terms, as food price, income, and relative availability of healthy food in the market compared to non-healthy products are barriers to a nutritious diet.

Research has found that immigrants to the United States consider items such as fruits and vegetables to be less accessible than in their home country. Additionally, they are deterred to buy them given pesticide content fears (Yeh et al., 2008), particularly because of the fact that many immigrants come from less developed countries.

However, it is common to find these arguments in completely different locations and other demographic groups.However, studies have shown that a healthier diet does not cost significantly more compared to unhealthy produces (Grech et al., 2017; Rao, Afshin, Singh, & Mozaffarian, 2013). The idea of healthy foods being more expensive is also nurtured by the financial instability of young adults, leading to money-saving practices.A different study, in Italy, found that not only the costs of vegetables and fruits and the fear for pesticides residuals are restraining variables when going to grocery stores, but also the easily perishable status they have (Menozzi, Sogari, & Mora, 2017) or the need to cook them. These features represent additional costs as means of more frequency to obtain the products and supplementary resources to prepare dishes. Moreover, the same study reveals that the consumption of vegetables in Italy, a widely known producer of various food products and exporter to all Europe, is decreasing among young adults. In junction with the availability of less healthy products, generally processed food and pre-cooked meals are cheap to acquire at supermarkets, leading the costs of nourishment to show a definite fashion.

Furthermore, some argue that there has been a decrease in the costs of unhealthy food production, consequently lowering the costs of consumption. As this lowers the amount of time and effort required to produce and consume packaged aliments, there is also a rise on sedentary lifestyles and a vast array of pharmaceutical products and medical procedures to tackle obesity, that along with ‘labor-saving technology and convenient, affordable food’ (Finkelstein & Strombotne, 2010), ensure an obesity inclined environment for society in general.Nonetheless, better solutions need to be found in order to increase the accessibility to healthy diets. A prospective approach could be subsidizing young adults for aliments, in order to lower the financial barrier, while universities should adopt regulations for impeding the close proximity of fast-foods to campuses, as one study suggests (Munt et al.

, 2017). 2.2.5. Lack of knowledge and risk-taking behaviorDespite the fact that young adults are aware of what a healthy diet entities and why it is necessary, many subjects opt for unhealthy food choices, without considering the effects on their future health status.

At an age at which they are exposed to a risk-taking behavior due to the desire the experiment and self-identify, dietary habits make no exception. Due to what is known as “delayed gratification”, young adults prefer the immediate benefits brought up by the consumption of fast-foods in detriment of the long-term effects that an unhealthy diet has. This is an important aspect for general practitioner’s to discuss, as any intervention that targets this age cohort needs special tailoring for the needs and behavior that is associated with young adults (Munt et al., 2017).2.

3. Intrapersonal barriersThrough the fast pace at which the transition from adolescence to young adulthood happens, individuals experience an immense load of stress and pressure. This is why, young adults are very susceptible to many emotional experiences which were shown to affect the apetite and affinity for specific foods. While trying to balance a normal life style with an active social life, often times, under the emotional stress they experience, students and young professionals resort to finding comfort in sweet foods or a high caloric intake. This response is due to the better sensorial experience offered by unhealthy foods compared to healthy ones. Additionally, the individual differences between subject’s motivation to follow a healthy diet lead to discrepancies in weight gain within this age cohort.

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