Consumption of seafood—the influence of overweight and health beliefs

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Abstract

This study investigated the relationship between self reported body weight and health perceptions and choice of seafood in a region with a traditionally high-level of fish consumption. A random sample of women aged 45–69 years who live in northern Norway answered a self-administrated questionnaire about eating habits, socioeconomic factors and questions related to health sent to them by mail; 7556 women answered the questionnaire (56.1% response rate) which was analyzed by logistic regression methods in which odds ratios (OR) were calculated. The mean frequency of consumption of seafood was 15 times a month. Some 46% of the respondents were overweight, 77% agreed that food is important for health and 55% had a desire to reduce weight. Overweight women consumed less lean fish than normal weight women (OR=0.8). Fish consumption was not associated with the desire to reduce weight. Fat and lean fish, but not processed fish, consumption are associated with the perception that food is important for health. A generally healthy food consumption pattern was strongly associated with weekly fish consumption, with normal weight and with the desire to reduce weight. Very high family income was associated with higher fat fish consumption (OR=1.9) normal body weight and for the desire to reduce weight (OR=2.1). High fish consumption in childhood and the belief that food is important for health were strongly associated with high fish consumption (OR=2.1 and 1.4 respectively for lean fish). Kids <7 years in the household are associated with processed fish consumption (OR=2.9) but not with the belief that food is important for health, that association is made by teenagers in the household (OR=1.4). Education is associated with high fat fish consumption, while increasing age is strong associated with high lean fish consumption (OR=1.88 for >60 years compared with 45–49 years). It is concluded that the desire to reduce weight does not influence fish consumption, but overweight women consume less lean fish than women of normal weight. Normal body weight and the desire to reduce overweight are associated with a broader healthy lifestyle pattern, in which seafood has a role in the diet. Higher fish consumption is associated with increasing consumers’ belief and behavior according to food's importance to health, high fish consumption in childhood and a higher level of education and income.

Introduction

An understanding of important factors associated with high fish consumption will be useful to seafood marketers and should help them improve promotion communications, product perceptions and distribution. Health educators also need better knowledge to make their campaigns more effective. This paper investigates the relation between self reported weight and health perception and fish consumption in an area of traditionally high fish consumption.

The background is that whilst modern malnutrition increasingly is accepted as a threat to health, the new food-related lifestyle epidemic is being overweight or obese,1 which may lead to diabetes, cardiovascular diseases, etc. (WHO, 1998). 39% of the Norwegian women 45–69 years are overweight (Hjartaker, Laake, & Lund, 2001). This is much lower than for example in the US where 65% of all women 45–54 years and 73% of women 55–64 in 1999–2000 were overweight (BMI>25.0) as compared with 60 and 59%, respectively in 1971–1974 (Centers for Disease Control, 2001). Medical research has, however, shown that a high consumption of fish oil (omega-3), e.g. cod liver oil or fatty fish, reduces the risk of several of the lifestyle diseases (Connor & Connor, 2000). Substituting the intake of fatty meat with a mixture of seafood and vegetables might improve the quality of the fat consumed and reduce consumers’ total calorie intake, and could prevent lifestyle diseases. Based on such knowledge, medical authorities, nutritionists and physicians recommend several options of health-oriented strategies, in which diet, exercise and use of medical treatment are combined (WHO, 1998).

Seafood consumption has increased in the past decade, which combined with limited supplies has resulted in higher seafood prices. Globally average seafood consumption per capita in the world reached 15.9 kg in 2000 (live fish weight equivalent), an increase of 15.2% from 1990. Significant variations in this overall trend are evident; for example Asia showed strongest growth, while seafood consumption decreased in Africa and America. In Norway per capita consumption was 51.2 kg in 2000, an increase of 13% since 1990 (FAO, 2002). Patterns of food consumption in Norway have also changed, and people have reflected a general shift from beef to chicken and fish (Rickertsen, 1996). Changes in consumer attitudes seem to be important driving factors for the increased consumption of fish, despite it becoming an increasingly expensive good. How is this trend influenced by consumers’ beliefs about food and health?

Earlier studies have shown that recommendations about healthy eating influence consumers’ beliefs about food and health and the pattern of food consumption (Harel et al., 2001, Nayga, 2000, Variyam et al., 1998). Generally, health information has been shown to be efficient in influencing food and seafood consumption (Foxall, Leek, & Maddock, 1998). In the US poultry market, the elasticity in health information in general has been found to be larger in absolute terms than the elasticity in price, which means that one may get more sales from investment in food-health information than from using similar percentage price reductions (Kinnucan, Xiao, Hsia, & Jackson, 1997). On the other hand, negative food-health information may also have a tremendous adverse impact on food consumption as illustrated by the linkage in the media between meat consumption and bovine spongiform encephalitis (BSE) (Verbeke, Viaene, & Guiot., 1999).

Earlier studies have indicated that information about healthy food penetrates differently into different sectors of the population. For example, women tend to comply with dietary guideline recommendations from written materials, their social networks and relatives/friends more so than men. Men are influenced more by the mass media and by physicians (Fagerli and Wandel, 1999, Mcintosh et al., 1995, Turrell, 1997).

When it comes to seafood it is not so clear how perceptions of the link between food and health influence consumers’ attitudes towards seafood and the pattern of seafood consumption in different market segments. Altekruse, Timbo, Headdrick, and Klontz (1995) have shown a positive relationship between seafood consumption and health consciousness. Fish eaters were significantly more likely than others to report recent exercise, efforts to lose weight, periodic monitoring of serum cholesterol, and being non-smokers. Dietary behavior and its relative saliency in food choice also reflect such diverse determinants as socioeconomic factors, food preferences, beliefs, skills in preparation and local supply of fish products (Myrland et al., 2000, Turrell, 1998).

Region of residence has been shown to be a significant independent factor associated with seafood consumption (Myrland et al., 2000). Food consumption patterns are strongly related to local food supply (Nestle et al., 1998). Local food sources make it possible to prepare quality meals from fresh raw materials; they provide a foundation stone for the dissemination of taste preferences, meal preparation and eating practices over the generations and throughout the marketing channels. Limitation in local supply of fresh fish and shelf life are therefore important constraints for regional variations in seafood consumption. The effect of the dissemination of health information on food practices can therefore be expected to differ between coastal regions and other regions. The appeals to adopt health and food messages accord with diffusion theory: they are expected to be highest if the adopters do not have to change consumption habits (Rogers, 1983). Most studies of the impact of health perceptions on food consumption have focused on consumer groups in low fish consumption regions where high prices and lack of quality supply might be significant barriers to consumption. It is therefore interesting, as done in this paper, to identify health motivated drivers for the changing food consumption patterns towards more seafood consumption in the coastal areas where supply of fresh cheap seafood is an insignificant constraint for consumption.

The aim of the study is to deepen our understanding of the association between the consumption pattern of fish and health factors including overweight and beliefs about healthy eating. The data are controlled for other socioeconomic factors and food consumption patterns in a region where fresh seafood is widely available.

Earlier studies have shown positive association between seafood consumption and products that contain healthy components such as polyunsaturated fatty acids (Foxall et al., 1998). An earlier study of a representative sample of Norwegian women 45–69 years showed that seafood consumption increased with increasing belief in the idea that diet is important for health (Trondsen, Braaten, Lund, & Eggen, in press). However, not all seafood products, notably processed fish products (fish cakes, puddings and sticks), normally contain polyunsaturated fatty acids.

Earlier studies have shown that higher consumption of recommended healthy foods, such as fish and potatoes, is related to a lower consumption of meat, chocolate and alcohol among older women (Hjartaker and Lund, 1998, Johansson et al., 1997). Most fish especially lean fish products are low in calories. Increasing the seafood content of consumer's diet might therefore be associated with body weight.

Earlier studies have shown a positive association between socioeconomic status, exercise, weight control, and healthy diet (Hjartaker and Lund, 1998, Jeffery et al., 1991, Johansson et al., 1999, Tucker et al., 1995, Uitenbroek et al., 1996). The frequency of seafood consumption is also linked to healthy diet and the use of medicine for cardiovascular disease (Trondsen et al., in press). Health variables have also been associated with consumption of fatty fish (Altekruse et al., 1995). Changes in fish consumption patterns may therefore be associated with a broader trend in healthy food consumption driven by socioeconomic and lifestyle trends; even in regions with good access to reasonably priced fresh fish.

Household income is expected to influence food choices, especially potentially costly food such as fish, fresh fruit and vegetables (Nestle et al., 1998). Household size, presence and age of children are expected to change food consumption patterns, for example due to conflicting preferences within the household and difficulties of preparing fish dishes (Myrland et al., 2000, Young, 1987). Age and level of education reflect that more experience and knowledge may influence the perception of the relationships between food, health and after meal feelings (Martinez Gonozalez et al., 1998, Nestle et al., 1998, Shi, 1998).

Earlier Norwegian studies have found that seafood consumption among women 30–44 and 45–69 years old increased with bigger household sizes and older age. While higher education levels, not income, were most important for seafood consumption in the youngest cohort, low income not education level was most important for seafood consumption in the older cohort (Myrland et al., 2000, Trondsen et al., in press). The question to be raised is how these socioeconomic factors are associated with seafood consumption directly and indirectly by association with the desire to reduce weight and beliefs about food and health.

Fig. 1 shows the main relationships to be investigated.

Section snippets

Materials and methods

The Norwegian Seafood Consumption study (NSCS) is based on data collected as a part of the “The Norwegian Women and Cancer Study” (NOWAC) in 1997. The main objective of the study is whether or not seafood in the diet helps protect against several health problems. The study includes information on self-perceived health and health problems, healthy food attitudes, demographics, eating habits and more traditional non-market variables. Product prices, a central variable in any demand analysis, were

Sample characteristics

Table 1(a) shows that 90% of the responders were born in northern Norway and 5% in the western and middle (Trøndelag) coastal regions. There were 65% respondents with low and very low income (<NOK 300,000/US$ 42,000 a year). The level of education was low, since 67% of the respondents reported less than 10 years of education. More than half of the respondents lived in two-person households, and 16% were single. Of the households, 17% included teenage children.

Regarding health issues, 13% of the

Discussion

The response rate in this study was 56% and vulnerable to non-response bias. However, the distribution of lifestyle factors did not, vary according to response rate in another part of the NOWAC study of adult Norwegian women (Lund & Gram, 1998). The study includes women only, but earlier studies of the at-home consumption of seafood in Norway and the USA have shown no difference between the sexes (Fagerli and Wandel, 1999, Myrland, 1998, Nayga and Capps, 1995). The study did not include

Conclusion

The main question in this study was: How does self reported body weight and health perceptions influence choice of seafood in a region with a traditionally high-level of fish consumption? The findings show that overweight in itself is associated with increasing age and health status, household structure, physical activity and the food consumption pattern. Overweight women consume less lean fish than normal weight women. Consumption of vegetable and fruit (5-a-day), smoking and physical

Marketing implications

Even if seafood consumption in northern Norway is high compared with other regions, this study shows several important opportunities for both health authorities and the seafood industry to improve seafood consumption and sales in market sectors where the benefit of seafood as a lean healthy food has not been fully utilized and where 26% stated that they are not eating enough fish. All promotion and health information that strengthens the knowledge about the positive relationship between food

Acknowledgements

The authors wish to acknowledge financial support from the Norwegian Research Council and the Norwegian Cancer Society. Thanks also to professor Jimmy Young and the two anonymous reviewers for constructive comments on an earlier draft of this paper.

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