Concepts of Healthy Eating Phase I (Lewisham), 1992-6

Key Terms: Food and health, food choices, Lewisham, 'healthy eating'

Names of investigators:
Principal Investigator: Professor Pat Caplan
Research Associates (half-time): Anne Keane, Anna Willetts

Institutional affiliation:
Department of Anthropology, Goldsmiths College, University of London

Rationale:
This project was set up to investigate people's own notions of the relationship between the food they ate, and their health. In order to do this it was considered important to situate people's food choices in their social and cultural context.

Summary of aims and objectives

• To accumulate new information on food choices in Britain and the processes - social, cultural, political and economic - which lead to such choices in a diversity of settings, and in a rapidly changing situation.
• To encourage greater understanding of people's ideas about the relationship between food and health which may prove of practical use in seeking to improve diet and therefore morbidity and mortality rates.
• To refine anthropological theory and methodology in the area of food and diet by combining the approaches of political economy and cultural analysis, and by working at the micro-level, but situating the research in a much broader political, economic and geographical, as well as historical context.
• To demonstrate the value of anthropological analysis, especially the importance of symbolism, categorisation, and social relationships in the understanding of people's choice of diet.

Study Design

This study was located in the London borough of Lewisham. A variety of methods was used in this research, including open-ended, semi-structured interviews with both general informants and with retail, catering and health professionals. General informants included men and women of all ages, both black and white British, from middle and working class backgrounds. Selected informants also kept 7-day food diaries, and filled in food frequency questionnaires.

The researchers also engaged in participant observation by joining several local cookery classes and attending meetings and other activities of groups in the area concerned with food, including some focussed on weight-loss diets and exercise, and others on the provision of meals for the elderly. A series of observations and short interviews in local cafes and take-aways was also carried out.

In addition to the above primary data, secondary data on the area itself, and on food in Britain and the West more generally, was gathered.

All of the interviews with both general and professional informants were transcribed and entered on to a computer data-base (QSR NU.DIST) which allows for sophisticated analysis of textual material. Food diaries were also entered onto computer, and into the NUDIST data-base. The food frequency questionnaires were were analysed by means of the Paradox data-base to obtain general statistical data about frequency of consumption of particular foods and to round out studies of particular households already interviewed.

Main findings

1. Patterns of diet are complex, and cannot always be correlated in any simple way with factors such as ethnicity, class, or age, although these are important. In this study, they have been considered in the context of household composition and organisation, time and money budgets, and cultural notions about what constitutes 'good food' and health.
2. The 'proper meal', which has to be cooked from at least some raw ingredients, remains an important ideal norm, although it is not always adhered to by informants on a daily basis. Informants cite time, or lack of it, as a determining factor in whether or not they eat a proper meal, but it is also apparent that age, household composition, and stage of the life cycle are also significant. Informants in Lewisham regularly ate convenience food at home, take-aways, and fast food, particularly during the week, but most households still ate home-cooked food in a conventional meal format several times a week.
3. It is apparent that for all but the older informants, a wide variety of foods is eaten, including pasta dishes, curries and Chinese food, none of which is characterised by them as 'foreign' food. Only a few informants, mostly those over 60, adhered to a 'traditional' British diet, although most others could characterise it ('meat and two veg', 'no spices').
4. 'West Indian' food is an important aspect of black identity and was eaten by the vast majority of African Caribbeans on at least an occasional basis. Older residents born in the Caribbean tended to eat it regularly, but younger people tended only to eat it at weekends, often returning to their parents' house, or on special occasions.
5. Economic constraints played a part in ability to adopt a 'healthy eating' diet: families on low incomes, especially those with children, had often of necessity to choose inexpensive ways of eating, which might include foods relatively high in sugar and fat.
6. The vast majority of informants were well aware of the current guidelines on healthy eating, but the extent to which they were willing to adopt them varied and many were highly sceptical of their efficacy. Balance, variety and moderation were key concepts which mediated the contradictions between what informants thought constituted healthy food, and the reality of their daily diets.
7. Nonetheless, dietary changes for health reasons were apparent:
   a) Some people had changed their diets in small ways such as eating brown bread or switching to low-fat margarine. This decision was often attributed to information which is 'around': the television was frequently cited in this regard.
   b) The most significant changes in diet were usually made because of a personal health problem such as a diagnosis of high blood pressure or diabetes. People were willing to make changes when health issues affected them directly, and when advice about how to do so was given by a friend, relative, or known and trusted health professional. They were much less likely to do so as a result of mass campaigns around issues like heart disease which were seen to be long-term risks which might never materialise.
   c) There was a minority of informants seeking to live an 'alternative' lifestyle and who had ideological, as well as health reasons for conforming quite closely to current nutritional wisdom. Their diet was likely to include organic, and perhaps vegetarian or vegan food, and some grew their own vegetables. However, boundaries between alternative and mainstream lifestyles were highly permeable.
   d) A large number of interviewees in SE London evinced concern about food safety, particularly in the light of recent food 'scares'. Some had changed their food habits on a long or short term basis, particularly in regard to the eating of beef.
   e) There was a high degree of anxiety on the part of women about their bodies; most white women and many younger black women interviewed in SE London were, had been, or were planning to go on a weight-loss diet.

Conclusions

Thus study has addressed, inter alia, reasons for the relative failure of healthy eating campaigns and why people eat what they do when they 'know' it is unhealthy. It has done so by analysing various forms of knowledge, incorporating both lay and expert notions of risk and scepticism, as well as cultural notions of the body and its relation to food. It has also studied some of the social relations involved in purchase, preparation and consumption of food, showing that what people eat is not only based upon individual choices and preferences, but is formed and constrained by circumstances which are essentially social and cultural.

Publications: books and working papers

• 1994. P. Caplan. 'Feasts, fasts, famines: food for thought' Berg Occasional Papers in Anthropology no. 2. Berg Publishers, Oxford and Providence USA, 1994, pp. 35.
• 1995. A. Keane and A. Willetts. Concepts of Healthy Eating: an Anthropological Investigation in South East London. Goldsmiths College Working Paper, London 1995. ISBN 0-902986
• 1997. P. Caplan (ed.) Food, Health and Identity, Routledge, London and New York, July 1997. 280 pp. ISBN 0-415-15680-7

Articles and chapters in books

• 1993. Anne Keane and Anna Willetts 'A bellyful of words' The Guardian, London, 6th August.
• 1994. Anne Keane and Anna Willetts. 'Factors that affect food choice' in Nutrition and Food Science, no. 4. July-Aug 1994, MCB press, pp. 15-17
• 1995. Anna Willetts and Anne Keane 'You eat what you are', The Guardian Weekend London, April 5th, pp. 42-3.
• 1996. P. Caplan. 'Why do people eat what they do? Approaches to food and eating from a social science perspective' Clinical Child Psychology and Psychiatry, 1, no. 2. Sage London, Thousand Oaks (USA) and New Delhi, 1996. pp. 213-227.
• 1997. Anne Keane: Normality and the body as Potential: Conceptualising Food and the Self. An Anthropological Study in South-East London. University of London Ph.D.Pp.310
• 1997 A Keane. 'Hard to Swallow: the palatability of healthy eating advice' in P. Caplan (ed.) Food, Health and Identity. Routledge, London and New York. 1997, pp. 172-92
• 1997. Anna Willetts. 'Bacon sandwiches got the better of me' in Food, Health and Identity ed. P. Caplan, Routledge, London and New York 1997. pp. 111-30.
• 1998. Pat Caplan, Anne Keane, Anna Willetts, and Janice Williams. 'Studying Food in its Social And Cultural Contexts: approaches from an anthropological perspective' in A. Murcott (ed.) 1998. The Nation's Diet. London, Longman.
• 1999. P. Caplan and A. Keane. 'The wisdom of the experts: health professionals' concepts of healthy eating' in B. Kohler and E. Dowler (eds.) 1999. Public Health and Nutrition Sigma Publications, Berlin