SeriesFood choice in transition: adolescent autonomy, agency, and the food environment
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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All authors after the first author are listed in alphabetical order