Elsevier

The Lancet

Volume 399, Issue 10320, 8–14 January 2022, Pages 185-197
The Lancet

Series
Food choice in transition: adolescent autonomy, agency, and the food environment

https://doi.org/10.1016/S0140-6736(21)01687-1Get rights and content

Summary

Dietary intake during adolescence sets the foundation for a healthy life, but adolescents are diverse in their dietary patterns and in factors that influence food choice. More evidence to understand the key diet-related issues and the meaning and context of food choices for adolescents is needed to increase the potential for impactful actions. The aim of this second Series paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. We describe patterns of dietary intake, then draw on existing literature to map how food choice can be influenced by unique features of adolescent development. Pooled qualitative data is then combined with evidence from the literature to explore ways in which adolescent development can interact with sociocultural context and the food environment to influence food choice. Irrespective of context, adolescents have a lot to say about why they eat what they eat, and insights into factors that might motivate them to change. Adolescents must be active partners in shaping local and global actions that support healthy eating patterns. Efforts to improve food environments and ultimately adolescent food choice should harness widely shared adolescent values beyond nutrition or health.

Introduction

Nutrition is central to adolescent growth and the realisation of potential.1 Recent calls to address malnutrition in all its forms among adolescents emphasise the importance of multisectoral approaches to improve diets,2 but programmatic action to do so across most countries is woefully lagging. Adolescence is the time of transition from primary dependence on caregivers to increasingly diverse roles and responsibilities related to food acquisition, preparation, and consumption, presenting a unique opportunity to foster healthy eating. Yet adolescence is not universal in its nature or duration across sociocultural contexts.3 To foster healthy eating during adolescence, an in-depth understanding of adolescent dietary intake and food choice across different contexts is essential.

These many contextual factors are depicted in this Series' conceptual framework,4 including natural, social, cultural, political, and economic systems. For dietary intake and food choice, these factors manifest in the so-called food environment, defined as the point of interaction of consumers with the food system, where they make decisions about acquiring, preparing, and consuming food.5, 6, 7, 8 For the individual, this is captured in the experience of availability, affordability, desirability, and convenience of food.9 Throughout the day and over time, adolescents might be exposed to varying food environments, including home, school, workplace, and formal and informal markets.

The aim of this paper is to elevate the importance given to adolescent dietary intake and food choice, bringing a developmental perspective to inform policy and programmatic actions to improve diets. In the first section, we illustrate the importance of the issue by describing patterns of dietary intake among adolescents. In the second section, we draw on existing literature to map how food choice can be influenced by unique features of adolescent development. In the third section, we use pooled qualitative data combined with evidence from the literature to explore the ways in which adolescent development can interact with sociocultural context and the food environment to influence food choice, ending with a series of key considerations for policies, programmes, and further research.

Section snippets

Current knowledge of dietary intake and pattern among adolescents

A 2019 review from Europe, the USA, Canada, Australia, and New Zealand found 13 surveillance systems of adolescent diets but identified serious limitations in data quality and comparability.10 A 2018 systematic review of dietary intake among adolescent girls from low-income and middle-income countries (LMICs) also highlighted critical gaps in data and noted the absence of data for boys.11 Here we explore three data sources to highlight current knowledge of dietary intake patterns. First, we

Food choice at the intersection of adolescent development, sociocultural context, and the food environment

Story and colleagues15, 16 explain adolescent dietary behaviours using a model drawing on social cognitive and ecological theory. Analogous to the conceptual framework of this Series,4 food-related behaviour is explained as a reciprocal interaction across four levels of factors: individual (psychosocial, neurodevelopmental, biological, lifestyle); social environmental (family, peers); physical environmental (community setting); and macro systems (eg, media and social or cultural norms). As

An exploration of influences on adolescent dietary intake and food choice

We explored influences on adolescent food choices using a pooled analysis of qualitative data from 11 studies with adolescents and adult informants from eight countries (Bangladesh, Côte d'Ivoire, England, Ethiopia, India, Indonesia, South Africa, and The Gambia). For each study we classified context as a traditional, mixed, or modern food environment based on the criteria of the High-Level Panel of Experts on Food Security and Nutrition8 (for details, see appendix p 10 and pp 15–18). This was

Conclusions

Dietary intake during adolescence sets the foundation for a healthy life, but adolescents are highly diverse in their dietary patterns, developmental trajectories, and in the factors that influence food choice. Contextual factors are central to food choice among adolescents, but even the interpretation of choice is highly contextual, with individual decisions inextricably linked to gendered roles and responsibilities in traditional food environments. Our findings reinforce the importance of

Declaration of interests

MB reports grants from the UK Medical Research Council and grants from the UK National Institute for Health Research (NIHR), during the conduct of the study. All other authors declare no competing interests.

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