Influence of the Socio-Cultural Environment and External Factors in Following Plant-Based Diets

Barriers to Adopting a Plant-Based Diet in High-Income Countries: A Systematic Review

Adopting a plant-based diet (PBD) has been shown to reduce the risk of developing certain diseases and is linked to environmental benefits. This review synthesises the evidence on the barriers adults aged 18 to 65 living in high-income countries (HIC) may experience when adopting a PBD. A systematic literature review was conducted using four search databases: Medline, Embase, Global Health, and Web of Science. Barriers were mapped to behaviour change strategies using the COM-B model. Ten studies were included in the final review, including 1740 participants. Five were qualitative, four were cross-sectional, and one was a pre- and-post-intervention study. In total, 40 barriers were identified and synthesised into 11 themes: financial, lack of knowledge, emotional, health, convenience, social, enjoyment of meat, environmental, accessibility, personal ability, and media. Of the 40 barriers, nutritional intake/requirements (categorised into the "health" theme) had the most evidence. This barrier encompassed concerns around being able to meet nutritional needs if an individual were to adopt a PBD. Habits (in the "personal ability" theme), which included established eating habits and habitual behaviours relating to animal-source foods, had the second most evidence alongside the barrier of not knowing what to eat as part of a PBD (in the "lack of knowledge" theme). Education interventions and communication/marketing policies were the behaviour change mechanisms mapped onto these barriers. Future interventions should focus on informing individuals about what to consume as part of a nutritionally balanced PBD and facilitating habitual dietary change.

Analysis of ingredient list and nutrient composition of plant-based burgers available in the global market

The nutrient composition of plant-based burgers is a key factor when making their purchase/consumption decision to maintain a balanced diet. For this reason, ingredient list and nutritional information of burgers launched in the global market were retrieved from their labels. Products were classified based on the technology development, market position and region of the manufacturer. From the ingredient analysis, we observed a high heterogeneity in the ingredients used, a predominance of soy and wheat as main sources of proteins, and the increasing use of new protein sources (e.g. peas, other types of beans and pseudo-cereals). Oil was the most cited ingredient followed by salt. Nutritional composition varied mainly depending on the region with no clear pattern among countries. To less extent, technology development resulted in traditional products with lower amounts of protein and higher amounts of carbohydrates. Vegan and vegetarian products showed limited differences due to the high intra-heterogenicity.

Meat Consumption, Sustainability and Alternatives: An Overview of Motives and Barriers

Meat and meat products are important sources of protein in the human diet. However, their consumption or excessive consumption has been questioned as this has been related to sustainability and health issues. Due to this, alternatives to conventional meat consumption, such as meat produced more sustainably or meat alternatives, have been considered. The aim of the present work is to gain insight into the meat consumption of different countries, the motives for and barriers to this consumption, as well as into the consumption of more sustainably produced meat with particular focus on organic meat and meat alternatives. Information on meat consumption has been obtained using FAOSTAT data and maps have been constructed using SAS software. Results showed that, in general, albeit with variations between and within countries, there is a tendency to decrease red meat consumption and increase poultry consumption, while for pork consumption the tendency is less clear. Motives and barriers for meat and meat alternative consumption have been reviewed and it is possible to see that these are very variable and that they, in addition to the intrinsic and extrinsic characteristics of the meat, are also related to consumers' attitudes and beliefs. Thus, it is important to inform consumers in a truthful and reliable way in order to allow them to make well-founded decisions regarding the consumption of these products.

Perspectives of individuals on reducing meat consumption to mitigate climate change: protocol for a scoping review

INTRODUCTION

High consumption of red and processed meat increases the risk of several chronic diseases. Many people, especially in high-income countries, eat more meat than recommended by nutritional and health agencies. Meat production also has negative impacts on the environment and contributes to climate change. Therefore, climate protection, besides health or animal welfare, could motivate individuals to eat less meat. Willingness to reduce meat consumption and motives to do so are not yet fully understood.

METHODS AND ANALYSIS

Based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extended guidelines, a scoping review of peer-reviewed original studies will be conducted to address three questions: What is the evidence regarding (1) the willingness of individuals to reduce meat consumption to mitigate climate change, (2) the awareness of individuals about the link between their meat consumption and the potential to mitigate climate change and (3) individuals having reduced meat consumption for the reason of climate protection? We will search the databases Medline (via PubMed), Scopus, Embase, Greenfile (via Ebsco) and PsynDex/CurrentContent/Agris (via Livivo) using a systematic search string. Studies from 2015 onwards, published in English, German, Danish or Dutch, will be included. We will include observational studies, qualitative studies, intervention studies (if they include surveys) and reviews. Data will be summarised in a narrative synthesis, comprising methods, population characteristics, meat type under study, indicators measured and limitations. Key findings will be grouped according to the research questions. This scoping review will help clarify the role of climate protection in individual reduction of meat consumption and identify research gaps in this field.

ETHICS AND DISSEMINATION

Formal ethical approval is not required, as primary data will not be collected in this study. Findings of this scoping review will be presented at scientific conferences and published in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

https://doi.org/10.17605/OSF.IO/MWB85.

The Hidden Dangers of Plant-Based Diets Affecting Bone Health: A Cross-Sectional Study with U.S. National Health and Nutrition Examination Survey (NHANES) Data from 2005-2018

The plant-based dietary pattern has been recommended for its potential health and environmental benefits, but its association with bone loss needs to be further explored. This study aimed to investigate the association between three plant-based diet indexes and bone loss in 16,085 adults, using data from the National Health and Nutrition Examination Survey. Three plant-based diet indexes (PDI, hPDI, and uPDI) were calculated from two NHANES 24-h dietary recall interviews, to characterize a plant-based diet. A multinomial logistic regression model was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI). Higher hPDI and PDI were associated with increased risk of bone loss (OR_{Q5 vs. Q1} = 1.50; 95% CI: 1.24-1.81 for hPDI; OR_{Q5 vs. Q1} = 1.22; 95% CI: 1.03-1.45 for PDI), while higher uPDI was associated with increased risk of osteoporosis (OR_{Q5 vs. Q1} = 1.48; 95% CI: 1.04-2.11). A harmful association between plant-based diet indexes (hPDI and PDI) and osteopenia was observed at the lumbar spine rather than the femoral neck. We conducted several sensitivity analyses to ensure the robustness of results, including subgroup analysis, exclusion of people taking anti-osteoporotic and estrogenic drugs, further adjustment for menopausal status, corticosteroid usage, and dietary supplements, and calculation of E-value. Our study demonstrates the deleterious effects of a plant-based diet on bone health and emphasizes the importance of a balanced diet.

Marketing strategies used for alternative protein products sold in Australian supermarkets in 2014, 2017, and 2021

Introduction

Marketing plays an important role in consumers' perceptions and acceptance of new foods. The purpose of this study was to investigate the marketing strategies used for alternative protein products available in Australia in 2014, 2017, and 2021.

Methods

Product data were extracted from FoodTrack™, an established database of packaged supermarket products. Marketing strategies investigated included product format descriptors, front of pack (FOP) labeling claims, price, and in-store placement (2021 only).

Results

Data from 292 alternative protein products (n = 12 tofu-based products; n = 100 legume-based products; and n = 180 plant-based meats) were analyzed. Across the product range, "burgers" (n = 86), "strips and similar" (n = 51) and "sausages" (n = 42) were the most common product formats, accounting for ∼61% of the product range. Nutrient content claims featured on 273 (93%) products. "Positive" nutrient claims (those highlighting the presence of a nutrient) occurred on FOP labels four times more than "negative" nutrient claims (those highlighting the absence or low levels of a nutrient; 432 versus 101, respectively). Protein-related claims were the most common "positive" nutrient claim (n = 180, 62%). Health claims on FOP labels appeared on 10% of products. Most products (n = 265, 91%) mentioned a dietary pattern (such as "vegetarian" and "plant-based"), or a combination of dietary patterns on their FOP label. The price of alternative products increased over time; between 2014 and 2021, on average, the unit price increased (9% increase, p = 0.035) and the pack size decreased (14% decrease, p < 0.001). There was inconsistency in product placement across the eight stores visited. Occasionally (n = 3 of 13 locations), chilled alternative protein products were positioned near conventional meat products. More commonly, alternative protein products shared space with other vegetarian products (such as non-dairy cheeses and tofu blocks) or alongside convenience products, suggesting these products are promoted as convenience foods, or options for individuals with special dietary needs.

Discussion

This study provides a useful evidence base to understand the marketing strategies used for alternative protein products. It appears from this analysis that considerable effort has gone into providing consumers with a level of familiarity and comfort prior to purchasing these alternative protein products.

Validation and results of a novel survey assessing decisional balance for a whole food plant-based diet among US adults

Importance

Consuming a whole food plant-based diet (WFPBD) is a promising, low-risk strategy for reducing risk of prevalent chronic disease and certain cancers, with synergistic benefits for climate and environment. However, few US adults report consuming a WFPBD. Understanding the reasons for this inconsistency is important for developing and implementing interventions for promoting a WFPBD. However, no research to elucidate decisional balance driving current consumption patterns in the US exists.

Objective

This research aims to validate an online survey to assess decisional balance for the consumption of a WFPBD, describe attitudes and beliefs toward adopting a WFPBD, and evaluate socio-demographic differences in decisional balance for consuming a WFPBD among a convenience sample of US adults.

Design

Online cross-sectional data collection followed by confirmatory factor analysis (CFA), validation of internal consistency, and examination of invariance across socio-demographic variables. Sensitivity analysis of full vs. truncated survey to predict self-reported dietary patterns and consumption behaviors were evaluated. Results of the survey and significant differences by socio-demographics were assessed.

Setting

Online survey based on previous research, created via Qualtrics, and administered through MTurk.

Participants

A total of 412 US adults, majority female (66%), White (75%), 30-60 years old (54%), ≥ Bachelor's degree (85%), and earning ≥ $45K (68%).

Main outcomes and measures

Factor loadings, covariance of survey items, associations with self-reported dietary pattern and consumption measures, and differences in pros, cons, and decisional balance across socio-demographic variables.

Results

CFA reduced the survey from 49 to 12 items and demonstrated invariance across socio-demographic variables. Pros and cons varied inversely and significantly (cov = -0.59), as expected. Cronbach's α 's for subscales in the final, reduced model were high (>0.80). Pros, cons, and decisional balance in both the full and the reduced model were significantly (p < 0.05) associated with self-reported dietary pattern and consumption.

Conclusion and relevance

Our analyses indicate the WFPBD Survey is a parsimonious and psychometrically sound instrument for evaluation of decisional balance to consume a WFPBD diet among our sample of US adults. These results may be instrumental for development and deployment of interventions intended to promote consumption of a WFPBD in the US.

Plant-Based Only: Investigating Consumers' Sensory Perception, Motivation, and Knowledge of Different Plant-Based Alternative Products on the Market

Consumer acceptance and product development of sustainable, healthy, and tasty plant-based alternative products (PBAPs) are closely interlinked. However, information on consumer perceptions of the sensory profile of plant-based meat, cheese, and milk remains scarce. The study aimed to investigate German consumers’ (1) sensory evaluation of PBAPs and (2) consumers´ motivations and knowledge underlying the purchase of such products. This was analyzed in relation to different dietary styles of consumers (omnivore, flexitarian, vegetarian, vegan). A sample of 159 adults completed two tasks: first, a sensory test in which participants tasted and rated three different PBAPs in two consecutive sessions, and second, a questionnaire on consumption behavior, motivation, and knowledge. Results show few differences between nutrition styles in sensory evaluation of individual product attributes. However, overall liking was rated significantly higher by vegans than by omnivores. All dietary styles reported animal welfare and environmental aspects as the main motivations for consuming PBAPs. Most participants acknowledged that meat and cheese alternatives are highly processed foods and not a fad but are not automatically healthier or more environmentally friendly than their animal-based counterparts. Future research should focus on emerging product segments such as plant-based cheeses to better understand how consumers evaluate PBAPs.

Consumer motivations and desired product attributes for 2.0 plant-based products: a conceptual model of consumer insight for market-oriented product development and marketing

The plant-based product (PBP) market sector is rapidly growing, but there is a noted lack of qualitative data examining consumers’ perceptions of these products. This study aimed to examine consumers perceptions and usage of plant-based products and brands to further refine and extend our understanding of the different layers of contemporary plant-based consumption. Online consumer focus groups (n = 6) were used to gather qualitative data from consumers (n = 20) in Ireland and the United Kingdom. Qualitative analysis was conducted using NVivo v.26 where a content analysis procedure was used to reduce data into categories and sub-categories, after which data within categories was analysed to identify themes. Six overarching themes were identified: (1) Pro-social and moral motivations as most prominent in influencing PBP consumption; (2) Personal and sociocultural reasons as emerging motivators on PBP consumption; (3) Brand, ingredients, flavour and price as key attributes; (4) Natural, unprocessed PBPs as most appealing; (5) Replicating functional and nutritional properties of animal protein as more important than replicating sensory properties; and (6) Locally produced products and brands as preferred. A conceptual model of consumer insights required for market-oriented PBP development and marketing is produced. This model is consumer led, and confirms and extends/refines knowledge on motivations for consumption, evaluation of product attributes, and market gaps and improvements for a new generation of PBPs.

Thinking Health-related Behaviors in a Climate Change Context: A Narrative Review

BACKGROUND

Human activities have changed the environment so profoundly over the past two centuries that human-induced climate change is now posing serious health-related threats to current and future generations. Rapid action from all scientific fields, including behavioral medicine, is needed to contribute to both mitigation of, and adaption to, climate change.

PURPOSE

This article aims to identify potential bi-directional associations between climate change impacts and health-related behaviors, as well as a set of key actions for the behavioral medicine community.

METHODS

We synthesized the existing literature about (i) the impacts of rising temperatures, extreme weather events, air pollution, and rising sea level on individual behaviors (e.g., eating behaviors, physical activity, sleep, substance use, and preventive care) as well as the structural factors related to these behaviors (e.g., the food system); and (ii) the concurrent positive and negative roles that health-related behaviors can play in mitigation and adaptation to climate change.

RESULTS

Based on this literature review, we propose a first conceptual model of climate change and health-related behavior feedback loops. Key actions are proposed, with particular consideration for health equity implications of future behavioral interventions. Actions to bridge the fields of behavioral medicine and climate sciences are also discussed.

CONCLUSIONS

We contend that climate change is among the most urgent issues facing all scientists and should become a central priority for the behavioral medicine community.

It's not just about the food: Motivators of food patterns and their link with sustainable food neophobia

Food sustainability has been a growing focus in an attempt to limit climate change; as a result, the sustainable food market and an onset of social behaviors, such as shopping local and eating plant-based, is increasing. Limited however, is the understanding of how these sustainable food options are perceived among individuals who have different motivations for eating the way that they do. The situated identity enactment model and food neophobia literature are used to conceptualize the development of a model outlining how physical health, culture, and sustainability driven motivations of food patterns influence one's fear of sustainable food-moving beyond attitude as a suitable measurement in this context due to the complexity in the way select situational ques are cognitively processed. Data were collected among a representative U.S sample (n = 414) and analyzed through structural equation modeling using plant-based meat as the product of focus. Individuals whose food choices are culturally driven showed greater sustainable food neophobia and as motivations were more sustainability driven, the less fear they had of such foods. Contrary to what existing literature suggests, those driven by physical health showed no significance in the effects of their food patterns on neophobia even when considering a food option often positioned as healthier. Results also provided evidence of high local identity being a positive predictor of neophobia among those whose choices were culturally and sustainably driven. This study highlights the sensitivity of sustainable food and the importance of considering context, norms, and identity on food behaviors, regardless of one's underlying motives for food choices. Findings are influential in advancing social psychology literature on food behaviors and encourages the use of the model on other sustainable food products.

Intergroup Sensitivity and Promoting Sustainable Consumption: Meat Eaters Reject Vegans’ Call for a Plant-Based Diet

Reducing meat consumption can make immediate contributions to fighting the climate crisis. A growing minority adheres to meat-free diets and could convince others to follow suit. We argue, however, that recipients’ social identification as meat eaters may impede the effectiveness of such calls (i.e., an intergroup sensitivity effect based on dietary groups). Indeed, meat eaters in our experiment (N = 260) were more likely to reject calls for dietary change from a vegan than from a fellow meat eater. This effect was also evidenced in evaluations of and engagement with an initiative to promote a vegan diet (“Veganuary”), providing some indication for behavioral impact. In contrast, our societal dietary norm manipulation had no consistent effects on observed outcomes. Exploratory moderation analyses show a limited impact of participants’ social identification as meat eaters but highlight the role of peoples’ general willingness to engage in environmentally friendly behavior. We discuss theoretical and practical implications, including how our results challenge existing approaches to promoting a meat-reduced diet.

Diet and Consumer Behavior in U.S. Vegetarians: A National Health and Nutrition Examination Survey (NHANES) Data Report

An increasing number of individuals adopt plant-based diets for their potential health benefits. Understanding vegetarians' dietary behavior in the context of their socioeconomic background is essential for pro-vegetarian messaging and to influence public beliefs about plant food consumption. Thus, this study sought to investigate diet and consumer behaviors in U.S. vegetarians. This is a cross-sectional, population-based study with data from the Nutrition and Health Examination Surveys (2007-2010). Selected items from three modules (diet and nutrition behavior, consumer behavior, and food security) were compared between vegetarians (n = 352) and the general population (n = 14,328). U.S. vegetarians consumed significantly fewer calories and less cholesterol but more fiber than their omnivorous counterparts. Moreover, vegetarians had significantly fewer soft drinks and salty snacks available at home. We also observed significant intergroup differences with regard to the availability of fruit and dark green vegetables. Vegetarians spent less money on eating out and indicated a lower number of not-home-prepared meals and ready-to-eat foods. We found no differences regarding money spent at supermarkets or grocery stores. Our study contributes to a better understanding of dietary and consumer behaviors in vegetarians. We shed a new light on the economic feasibility of vegetarian diets, highlighting that these diets are not necessarily more expensive than an omnivorous diet.

Plant-Based Meat Alternatives: Motivational Adoption Barriers and Solutions

Meat consumption is increasingly being seen as unsustainable. However, plant-based meat alternatives (PBMA) are not widely accepted yet. PBMA aim to imitate the experience of eating meat by mimicking animal meat in its sensory characteristics such as taste, texture, or aesthetic appearance. This narrative review explores the motivational barriers to adopting PBMA while focusing on food neophobia, social norms and rituals, as well as conflicting eating goals that prevent consumers from switching to a plant-based diet. Based on the key characteristics of these motivational barriers, which are informed by research findings in consumer psychology and marketing, solutions are discussed that can help counter the barriers.

Nutritional Quality of Plant-Based Cheese Available in Spanish Supermarkets: How Do They Compare to Dairy Cheese?

Plant-based cheese is one of the most increasingly consumed dairy alternatives. Evidence is lacking on their nutritional quality. We aimed to evaluate the nutritional composition of the plant-based cheese options available in Spanish supermarkets, and how they compare with dairy cheese. An audit of plant-based cheese alternatives has been conducted in seven of the most common supermarkets. For each product, the nutritional content per 100 g and ingredients were collected. Data on generic dairy cheese were retrieved from the BEDCA website. Descriptive statistics (median, minimum and maximum) were used to characterize the plant-based cheese products, for both all the products and grouped by main ingredients (i.e., coconut oil, cashew nuts and tofu). Mann–Whitney U tests were used for comparisons between dairy and different types of plant-based cheese. The coconut oil-based products (the large majority of plant-based cheese products, n = 34) could not be considered as healthy foods. Their major ingredients were refined coconut oil and starches and were high in saturated fats and salt. The other smaller groups, cashew nut- (n = 4) and tofu-based (n = 2), showed a healthier nutritional profile. Replacing dairy cheese with these groups could be nutritionally beneficial. Future investigations should address the health effects of substituting dairy cheese with these products.

Lifestyle Adjustments in Long-COVID Management: Potential Benefits of Plant-Based Diets

Purpose of Review

The SARS-CoV-2-pandemic has caused mortality and morbidity at an unprecedented global scale. Many patients infected with SARS-CoV-2 continue to experience symptoms after the acute phase of infection and report fatigue, sleep difficulties, anxiety, and depression as well as arthralgia and muscle weakness. Summarized under the umbrella term “long-COVID,” these symptoms may last weeks to months and impose a substantial burden on affected individuals. Dietary approaches to tackle these complications have received comparably little attention. Although plant-based diets in particular were shown to exert benefits on underlying conditions linked to poor COVID-19 outcomes, their role with regard to COVID-19 sequelae is yet largely unknown. Thus, this review sought to investigate whether a plant-based diet could reduce the burden of long-COVID.

Recent Findings

The number of clinical trials investigating the role of plant-based nutrition in COVID-19 prevention and management is currently limited. Yet, there is evidence from pre-pandemic observational and clinical studies that a plant-based diet may be of general benefit with regard to several clinical conditions that can also be found in individuals with COVID-19. These include anxiety, depression, sleep disorders, and musculoskeletal pain. Adoption of a plant-based diet leads to a reduced intake in pro-inflammatory mediators and could be one accessible strategy to tackle long-COVID associated prolonged systemic inflammation.

Summary

Plant-based diets may be of general benefit with regard to some of the most commonly found COVID-19 sequelae. Additional trials investigating which plant-based eating patterns confer the greatest benefit in the battle against long-COVID are urgently warranted.

Perceptions of Vegan Food among Organic Food Consumers Following Different Diets

This article identifies consumer segments for vegan food by analysing perceptions of vegan food among food organic consumers following different diets: vegans, vegetarians, former vegetarians, flexitarians, and omnivores. The analysis is based on responses to a quantitative consumer survey for which 503 participants were recruited from customers at German grocery stores by quota sampling according to diet and region. From the responses to an open-ended question eliciting the participants’ associations with vegan food, the analysis finds that vegans and vegetarians perceive vegan foods primarily as being beneficial for animal welfare, healthy, and environmentally friendly, while those who ate meat perceive vegan food primarily as containing no animal ingredients and as being healthy. The respondents’ varying assessments of the taste, diversity, and environmental benefits of vegan food were found to differ in relation to the various diets they followed, as did their assessments of how long the vegan trend is likely to last. A cluster analysis based on the consumers’ perceptions and attitudes revealed three consumer groups: “vegan fans”, “enjoyment sceptics”, and “originality-sceptics”. Scepticism about the originality of vegan food was found in all diet groups. These findings can help inform more effective targeting of consumer needs for vegan organic food.