In Scotland, the prevalence of those overweight and obese remains high. There are many lifestyle factors that contribute to obesity, but, in general a major contributor is the diet is too high in calories, and contains too much processed food, fats, sugars, and salt and too little fibre that is found in wholegrains and fruit and vegetables.
In this blog, we outline our recent research on consumer attitudes and behaviours related to dietary fibre intake. The results enable us to better identify the priorities that could elicit change. The main challenge is to educate consumers that fibre is only found in foods originating from plants.
Dietary fibre is only found in plant derived foods like wheat, beans, fruit and vegetables but not meat, fish eggs or dairy produce. In Scotland the average intake of wholegrains and plant-based foods, including peas, beans and pulses, is low. For example, the recommend daily intake of dietary fibre is 30g/day for good health but the population, on average, consumes just over half of this amount.
Fibre consists of carbohydrates that are not digested and absorbed by the small intestine. Instead, they pass through the gut and arrive in the large intestine relatively intact, where they may be fermented by gut bacteria. They are broken down into smaller short chain fatty acid products that can be used as fuel by the gut bacteria or can be absorbed by the host. These fibre breakdown products can also trigger satiety hormone release which helps to regulate feelings of hunger. This means the fibre can make you feel fuller for longer, which can be helpful to control appetite and body weight.
In addition, fibre has been associated with helping:
- to prevent colon cancer,
- to lower cholesterol levels,
- to reduce the rate of release of sugar into the bloodstream, and is thought to reduce the risk of type 2 diabetes and coronary heart disease,
- to maintain digestive health and can prevent conditions such as constipation and other bowel disorders.
Despite these benefits, recent evidence indicates that in poorer UK households, daily fibre intake is lower, whilst in the wealthier households it is higher, with fibre intake increasing with increased income. Notably also, the proportion of obesity and poor diet consumption is higher in poorer socio-economic groups. Less nutritious, low fibre, energy dense foods are often cheaper, with higher diet quality associated with higher diet costs. Current high food inflation and the cost-of-living crisis is likely to worsen these socio-economic differences. Furthermore, and according to consumer-based evidence, messages highlighting the pressing need for dietary change towards higher fibre intake appears either to be being missed or ignored by consumers throughout Scotland.
Our research aim was to explore the reasons for inherently low fibre intake in Scotland, by considering the attitudes and perceptions of Scottish consumers to dietary fibre and its link to health, using an online consumer questionnaire survey. As part of our work, we considered the differences between the responses of Scottish and English consumers, from socially deprived through to wealthier geographical areas, and across the adult age spectrum.
Consumer Survey Method / Study design
To address the consumer-related aims, in total, 1119 adults aged over 18 years participated, with 610 and 509 respondents from England and Scotland respectively in October, 2022. This was conducted online with the help of Qualtrics XMTM software and registered consumers (Qualtrics). Evaluation of differences based on the influence of socioeconomic factors such as income, housing affordability and locality to key amenities (post offices, primary schools, supermarkets and GP surgeries) was based on postcode data from the Office for National Statistics and indices of deprivation from Scotland (Scottish IMD) and England (English IMD). The consumers were asked a series of questions on their understanding of what constitutes dietary fibre, their fibre intake habits, their perceptions and beliefs on the benefits or otherwise to different aspects of health, and whether they had or have intentions of changing their current habits with respect to fibre in their diets.
Survey Results / Outcomes
- Fibre Understanding
We found there is a limited understanding of foods that contain dietary fibre: Over 80% of respondents understood that legumes, cereals and fruits and vegetables were rich in dietary fibre, with a similar proportion agreeing that wholegrain foods have more fibre than non-wholegrain or processed foods. Although, it was encouraging that most people thought high fibre foods were palatable and were aware of many foods that contain fibre beyond cereals and multigrain products. Most were also aware of the health benefits from higher fibre intakes, beyond just gut health. However, these beliefs need to be taken in context with the unexpected finding that most people thought that non-vegetable foods contain fibre. Most (around 65%) thought that dietary fibre could be found in both vegetable and animal derived foods, with less than 20% disagreeing with this. This finding was reinforced by over 70% who disagreed that only vegetable foods have fibre and further reinforced by around 70% who disagreed with or weren’t sure regarding the statement that foods of animal origin such as meat, eggs and dairy products contain no fibre (unless added). On considering a statement that unpeeled fruit contained less fibre than peeled fruit, nearly half either agreed or were unsure. Thus, a significant degree of confusion exists over fibre-containing food sources.
- Fibre Uptake Concern
There was also a low level of concern amongst consumers over their fibre intake, with most people unconcerned. There appears to be little urgency amongst the respondents to increase their fibre consumption, but among those somewhat concerned, significantly more were of the young and middle-aged groups. Of those not concerned at all, most were in the oldest group, with significantly fewer in the middle-aged group and fewer still in the young group. Similarly, the young group were more likely to be either thinking about changing to higher fibre now or soon, whereas significantly more of the older group had no plans to change or were not interested in changing. These responses were the same across all regions being unaffected by deprivation status.
- Location and Demographic
There were very few differences in any of the responses between respondents from Scotland compared to England. Only around a quarter of respondents in both Scotland and England look for foods labelled high fibre but of those who don’t, slightly (but significantly) more were in Scotland. Three quarters of consumers either don’t even look for fibre on labels (~40%), or only sometimes (~35%) and most who do are amongst the younger groups irrespective of IMD status. Of those who check labels, significantly more were of the young group whereas of those who don’t check, significantly more were of the oldest group of respondents.
- Choosing Foods
When selecting food, significantly more participants from England said they would choose one labelled high in fibre. More respondents than not said they would choose high fibre labelled foods, but price was important across all ages and IMD areas. Of those thinking wholegrain foods were too expensive, significantly more were from the most deprived IMD areas.
- Fibre and Health
When asked whether respondents had increased their fibre intake in the last 6 months, amongst those who had increased intakes, the reasons given were better food choices, health reasons and weight management primarily, and fewer of the oldest group had made these changes. IMD status did not influence these choices.
Consumers are unaware of how much fibre they eat, how much they should eat or how much is in their food, irrespective of age or deprivation (IMD) area. This is despite the evidence that consumers are quite knowledgeable about many foods that do contain higher levels of fibre. The major concern is that most people have the flawed understanding that non-vegetable foods such as meat, fish, eggs, and dairy produce contain fibre. Our results show that most people obtain their fibre without realising or actively thinking about it.
Although price is important, it is not a barrier for most in preventing increased fibre intake irrespective of socio-economic status. Palatability does not appear to be an issue either and most would choose high fibre-labelled foods.
Despite understanding the potential benefits, fibre consumption is not currently a priority in terms of health goals, particularly amongst the more elderly respondents.
Priorities for Change
Consumers need to understand fibre is only found in plant-based foods. Furthermore, the health benefits of increased fibre are being missed, thus education appears to be the single most important tool.
As a reminder of which foods are sources of dietary fibre, foods that contains fibre come from any plant, bush or tree grown in soil, in other words, that don’t move. On the other hand, food contains no fibre if it is from sources that move, including those that swim, walk, run, or fly.
Food fortification would be recommended too as an aid to increasing fibre intakes. This may be achieved either covertly as ‘health by stealth’ or overtly, especially as there is general acceptance to this approach.
Encouraging people to eat more of what they already enjoy in terms of colourful foods amongst fruit and vegetables would be a positive way to increase fibre consumption.
Different platforms and media should be used for messaging the different age groups. Little messaging seems to be either broadcast or received from radio, which could be explored further. Age related messaging could be explored too, especially since the elderly are least inclined to increase their fibre intake despite often being the group most interested in decreasing future health risks.
Dr Alexander Ross; Professor Alexandra Johnstone; Claire Fyfe; Lynn Thomson
Rowett Institute, University of Aberdeen