Health Promotion International, Vol. 18, No. 2, 153-162,
June 2003
© Oxford University Press 2003
A cross-cultural analysis of ‘motivation for eating’ as a potential factor in the emergence of global obesity: Japan and the United States
1Department of Health Science, College of Health and Human Performance, Brigham Young University, Provo, UT, USA, 2Department of Family and Preventive Medicine, University of Utah College of Medicine, Salt Lake City, UT, USA and 3Otemae College, Osaka, Japan
Address for correspondence: Steven R. Hawks, Department of Health Science, 229-L Richards Building, Brigham Young University, Provo, UT 84602, USA E-mail: steve_hawks{at}byu.edu
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SUMMARY |
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 TOP SUMMARY INTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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This exploratory study compared motivation for eating between individuals from two different cultures that have moved through the nutrition transition at different rates and to different degrees. The analysis was based on a convenience sample of 1218 participants aged
18 years attending colleges in the US and Japan. The Motivation for Eating Scale (MFES) was used to evaluate different motivations for eating by nation and gender. The MFES consists of 12 items classified into three subscales: emotional, physical and environmental eating. The questionnaire used in the study also included responses about participants’ motivation to lose weight, frequency of dieting, presence of previous or existing eating disorders, and frequency of exercise. Results showed no significant differences in the three MFES subscales for men in the US and Japan. For women, however, significant differences were seen for all three subscales. Women in the US were more likely to initiate eating for emotional reasons, while women in Japan were more likely to eat for physical or environmental reasons. Women and men in the US were more likely than the Japanese respondents to eat in response to watching TV or movies. These results suggest that there are national differences in the cultural environment that may impact individual motivations for eating. As such, various cultural perceptions of food should be considered in attempts to understand more fully the mechanics of the nutrition transition as it operates within a given country. By extension, public health policies and health promotion initiatives that are designed to limit the negative impacts of the nutrition transition may benefit from a greater understanding of the larger role that cultural perceptions of food may play in influencing individual motivations for eating. Key words: cross-cultural studies; eating habits; health behavior; nutrition
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INTRODUCTION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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In part, the growing epidemic of global obesity can be explained by rapid changes in dietary patterns that are taking place in many developing societies. Specifically, traditional diets that are rich in grains, fiber, fruits and vegetables are giving way to modern diets that are high in fat, sugar and sodium (Popkin, 1994
). It has been argued that this nutrition transition is an expected consequence of the demographic and economic changes that accompany development (Popkin, 2001a). At the same time, it is possible that some aspects of the nutrition transition are not inevitable in that they occur in response to malleable social environments that are the product of evolving human cultures (Brown, 2001; Hawks, 2001). It therefore becomes interesting to consider the relationship between various cultures, the social environments that they produce, and the differential impacts that are exerted on individual eating habits.
In the past, the mechanics of the nutrition transition have largely been expressed in terms of the types of food people eat or how much they eat. For example, the relative proportion of fat intake, or measures of overall caloric intake, have been used to evaluate or predict population and individual levels of obesity (Hawks and Gast, 1998; Popkin, 2001a). At the same time, it may be helpful to broaden the inquiry to include why people eat (Gast and Hawks, 1998). By exploring individual motivations for eating, the larger relationships between individual consumption, various social environments and human cultures might be revealed. The perspective obtained from this line of investigation may be useful in refining our understanding of the nutrition transition, identifying innovative health promotion initiatives, and developing public health policies that can address negative aspects of the nutrition transition and help prevent the rising tide of global obesity in a meaningful way (Nestle and Jacobson, 2000).
This exploratory study begins to investigate the motivation for eating between individuals in two distinct cultures that have moved through the nutrition transition at different rates and to different degrees. The United States progressed through the nutrition transition over a period of ~100 years and has now fully transitioned from traditional to modern diets (Popkin, 2001a). Consequently, the US has now has one of the highest levels of obesity in the world (23.5%) (Flegal et al., 1998), and the prevalence of obesity continues to climb at alarming rates (a 55% increase between 1980 and 1994) (Mokdad et al., 2000). Currently, the US diet derives ~33% of calories from fat (Popkin et al., 2001).
Japan, on the other hand, went through the nutrition transition in only 50 years, but perhaps to a lesser degree (Drewnowski and Popkin, 1997). As opposed to the US, fat intake in Japan has leveled off at ~26% of total calories (Sugano and Hirahara, 2000), and <2% of the adult population is obese [body mass index (BMI) 30.0] (Yoshiike et al., 1998).
Given different rates of progress through the nutrition transition, different degrees of conversion to modern high-fat diets, and the presence of very different cultural traditions in relation to food, it was hypothesized that individual motivations for eating would differ for US and Japanese participants. Specifically, we looked for differences in personal motivation for eating in relation to environmental, physical and emotional cues, and we attempted to evaluate the relationship between individual motivations for eating and the cultural environments associated with them.
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METHODS |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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Subjects
Analysis was based on a convenience sample of 1218 college students aged
18 years attending schools in the US and Japan. College students were chosen because they are often at the forefront of the nutrition transition due to experimentation with new dietary traditions, attempts to enhance personal status, counter-culture impulses, and exposure to western media in urban centers (Drewnowski and Popkin, 1997; Pan et al., 1999). One college was chosen for sampling in Japan and two colleges in the western US. Participants were taken from large sections of general education courses. All students were informed about the purpose of the study, invited to participate, and given the option to withdraw without consequence.
Instrument
The Motivation for Eating Scale (MFES) was created to evaluate primary motivations that trigger eating behavior. Each of the MFES items is classified into one of the following subscales: physical, emotional or environmental. Physical eating occurs in response to hunger cues such as a growling stomach. Emotional eating is defined as eating due to depression, boredom, anger or other emotional states. Environmental eating is triggered by something in the immediate surrounding such as smelling food, hearing the lunch bell, or grabbing something at the check-out stand (Merrill, 1997).
As originally developed, the MFES contained 49 items that were selected after a thorough review of the literature. After submitting the scale to a panel of expert reviewers, some of the items were modified according to panel recommendations. The MFES was then administered to a convenience sample of 298 people, over half of whom were college students. Analysis revealed redundancy for six questions, which were subsequently removed. Internal consistency of subscales was considered satisfactory with alpha coefficients ranging from 0.80 to 0.95 (Merrill, 1997).
In addition to the MFES, a paper/pencil questionnaire was used to collect demographic information including nationality, education level and gender. The questionnaire also included items relating to the participants’ degree of motivation to lose weight, frequency of dieting, experience with eating disorders and frequency of exercise.
For the purposes of this study, the MFES and the questionnaire were translated into Japanese by two bilingual health and nutrition educators in Japan. Results of pilot testing indicated that student comprehension in Japanese was consistent with the original English intent. Due to resource constraints and a desire for a high response rate, four items from each subscale (physical, emotional, environmental) were retained from the original MFES questionnaire. The retained items, in combination with demographic and lifestyle data, were considered sufficient to answer research questions.
The survey was administered during class time by course instructors. Approval from appropriate institutional review boards was obtained.
Data analysis
Differences in the mean level of agreement in physical, emotional and environmental reasons for eating between the US and Japan were assessed using the t statistic. The normality assumption was reasonably satisfied. Equality of variances was assessed using an F statistic. Pooled variances or the Satterthwaite variance was used in computing the t statistic, depending on whether the assumption of equal variances was satisfied. Multiple regression models were estimated for each motivation for eating (physical, emotional, environmental) on demographic and lifestyle variables. Backward stepwise regression was used to delete insignificant variables.
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RESULTS |
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The overall response rate was 98%. Of the 1218 participants, 592 (48.6%) were in the US and 626 (51.4%) were in Japan. Almost three-quarters of the respondents were women (74.5%) compared with men (25.5%). Approximately 42.9% had a high-school degree, 34.8% had a 2-year degree and 22.3% already had a 4-year degree. The mean age was 21.0 years in the US (22.0 years for men and 20.2 years for women) and 21.5 years in Japan (22.2 years for men and 21.4 years for women).
Motivation for eating
The mean level of agreement on a four-point MFES scale in three general subscale areas related to motivation for eating (physical, emotional, environmental) is presented according to nation and gender in Tables 1 (men) and 2 (women). Where mean differences between the US and Japan are significant, there is a tendency for means to be higher in Japan for physical and environmental eating reasons, and lower in Japan for emotional eating reasons. Physical and environmental reasons were the primary factors influencing eating, followed by emotional reasons in both the US and Japan, and among both men and women.
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Overall, statistical significance occurred much more frequently for differences between US and Japanese women than between US and Japanese men. For men, differences between mean scores did not achieve significance for any of the three MFES subscales. On some individual MFES items, US men were significantly more likely to eat due to boredom or while watching TV, while Japanese men reported more eating when seeing something good at the checkout stand, when feeling weak or lightheaded due to hunger, or eating automatically because it was mealtime.
Mean scores differed significantly for women on all three subscales. Japanese women were more likely to initiate eating for both physical and environmental reasons, while US women were more likely to eat for emotional reasons. Only three individual MFES items failed to achieve significance, but in all three cases the direction of the difference followed the trend for other items in the same subscale. In fact, there is only one instance where an individual item fails to follow the larger trend of the subscale. In relation to environmental eating, US women outscored their Japanese counterparts on eating in response to watching TV, even though the Japanese had higher scores on all other items in the environmental subscale, and for the environmental subscale overall.
Associated variables
Measures of linear association between reasons for eating and selected variables are presented for men (Table 3) and women (Table 4). For men, five variables were significant in the model involving eating for physical reasons. Specifically: men in the US were less likely to agree that they ate for physical reasons; men currently trying to lose weight were more likely to agree that they ate for physical reasons; those who diet frequently were less likely to agree that they ate for physical reasons; those who felt they had an eating disorder were more likely to agree that they ate for physical reasons; and those who were physically active two to three times per month were more likely to agree that they ate for physical reasons.
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For the model involving emotional reasons for eating, three variables were significant. Men in the US were more likely to agree that they ate for emotional reasons; men who stated that losing weight was very important or always on their mind were more likely to agree that they ate for emotional reasons; and those who exercised almost daily compared with once a month or less were less likely to agree that they ate for emotional reasons.
For women, only the importance of weight loss was associated with physical reasons for eating. Women who indicated that losing weight was very important or always on their mind were more likely to agree that they ate for physical reasons.
In the model involving emotional reasons for eating, four variables were significant. Women in the US were more likely to agree that they ate for emotional reasons; women who stated that losing weight is very important or always on their mind were more likely to agree that they ate for emotional reasons; women who stated that they had had an eating disorder were more likely to agree that they ate for emotional reasons; and higher levels of physical activity were negatively associated with agreeing that they ate for emotional reasons.
Finally, in the model involving environmental reasons, four variables were significant. Women in the US were less likely to agree that they ate for environmental reasons; women who think losing weight is very important or always on their mind were more likely to agree that they ate for environmental reasons; frequent dieting was negatively related to agreeing that they ate for environmental reasons; and higher levels of physical activity were negatively associated with agreeing that they ate for environmental reasons.
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DISCUSSION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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Even though Japan and the US are both theoretically at the mature end of the nutrition transition, dietary fat intake and obesity levels differ significantly between the two countries (Sugano and Hirahara, 2000
; Popkin et al., 2001). One possible explanation for these differences may lie in the influence that unique cultural environments exert on individual motivations for eating. It was hypothesized as part of this study that a cross-cultural analysis of motivation for eating between Japan and the US might increase our understanding of the influence that cultural environments have on personal motivations for eating and may thereby help explain cross-cultural differences in diet composition and obesity.
Significant Japan/US differences
As predicted, significant cross-cultural differences in motivation for eating were discovered. Japanese women were more likely to eat based on physical and environmental motivations than US women, and were less likely to eat in response to emotional states. Trends were similar for differences between Japanese and US men, but subscale scores failed to achieve statistical significance for men. One interesting finding was that both US men and women were more likely than their Japanese counterparts to eat in response to TV or movie viewing, even though the Japanese were generally more likely to eat in response to other environmental cues.
In addition, multivariate regression analysis identified some interesting variables that were most closely associated with different motivations for eating. Some of the strongest associations in the regression analysis were related to emotional eating. High scores for emotional eating were associated with being from the US and feeling that weight loss is important (regardless of gender). The strongest consistent associations were between high scores on emotional eating and rating the importance of losing weight as ‘very important’ or ‘always on my mind’.
Cultural environments and motivation for eating
Emotional eating
An interesting paradox in the US has been the observation that higher rates of restrictive dieting have been taking place alongside rising levels of overweight and obesity (Heini and Weinsier, 1997). One possible explanation for this inconsistency is that in the US, the cultural concern with weight loss and thinness has led to restrictive dieting practices, eating disorders and dysfunctional relationships with food that actually promote physiological responses that result in higher rates of fat deposition, lower resting metabolic rates and, ultimately, increased weight gain (Gaesser, 1996).
This contradictory and unhealthy relationship with food among Americans is clarified by the finding that in comparison with four other countries, Americans associate food most with ‘health’ objectives and least with pleasure (Rozin et al., 1999). The French, on the other hand, are the most food-pleasure-oriented and the least food-health-oriented. In general, the French and Belgians tend to occupy the pleasure extreme, Americans the health extreme, and the Japanese somewhere in between.
Ironically, even though the Americans do the most to alter their diets in favor of improved health (such as weight control), they are the most likely to rate themselves as unhealthy eaters (Rozin et al., 1999). In their efforts to use food as a health tonic, Americans may actually eat less healthfully as they lose touch with physical, internal motivations for eating—including pleasure. For example, food taboos and restrictive dieting may lead to an urge to binge that has both physical and emotional components. In response, the overuse of energy dense foods to medicate this sense of deprivation may become characteristic of those who are most actively trying to lose weight (Van Strien et al., 1986; Goudy, 1997; Merrill, 1997).
This theory may help explain the relatively strong relationship between emotional eating and the desire to lose weight found in this study. It may also help explain the finding that in the US, emotional eaters are more likely to be overweight (Merrill, 1997). Other research supports the positive relationship between emotional eating and unhealthy eating habits in the west, and confirms the lower rates of emotional eating that this study found for Japanese women (Waller and Matoba, 1999).
Physical eating
Those whose motivation for eating falls mostly under the physical category of the MFES scale, however, are theoretically more likely to eat those things that are most physically satisfying, and hence most pleasurable. As opposed to the US, Japan is more likely to associate food with pleasure than with health outcomes (Rozin et al., 1999), and as a result there seems to be less restrictive eating and fewer cases of eating disorders (Nakamura et al., 1999b). Not surprisingly, this study found that Japanese women were more likely to eat in response to physical motivations. A cultural environment that supports physical motivations for eating may lead to a more natural relationship with food that in the long run leads to better food choices.
Environmental eating
Previous research in the US found that environmental eating was associated with higher BMI values (Merrill, 1997). Yet, both men and women in Japan ranked environmental eating high in this study. High environmental eating in Japan, along with low obesity rates, may be an indication that environmental eating in Japan and the US has different connotations. Interestingly, the biggest gaps in environmental eating between the US and Japan were related to spontaneous eating in response to seeing something at the checkout stand or eating at parties (Japan), as opposed to deliberate eating that occurs while watching TV or movies (US).
In Japan, some environmental eating may be more spontaneous and largely based on pleasurable associations with a wide variety of healthy foods that are selected primarily on the basis of physical or internal cues (Pan et al., 1999). Environmental eating in the US, on the other hand, may be related to the premeditated use of energy dense foods for emotional comfort and relaxation. If so, environmental eating among the Japanese may not contribute to excess weight and obesity as much as environmental eating in the US.
Future concerns
When comparing Japanese and US children (as opposed to adults), obesity and dietary differences all but disappear. Dietary fat intake among Japanese children has steadily increased to the present level of ~34% of total calories, and it is estimated that 10% of 5-year-old children are obese (Murata, 2000). Similarly, US children receive ~34% of calories from fat (Troiano et al., 2000), and the prevalence of obesity among 5-year-olds is ~10% (Ogden et al., 1997). For both countries, rising levels of dietary fat intake and obesity among children are attributed to skipping meals, irregular meals, high levels of snacking, a shift toward more fast foods and fried foods, excessive soft drink consumption, other ‘western’ eating habits and decreasing levels of activity (Takada et al., 1998; Sasaki et al., 1999; Takahashi et al., 1999; Murata, 2000; Troiano et al., 2000; Popkin et al., 2001).
In Japan, the increasingly ‘westernized’ diet is thought to contribute to rising rates of breast, colon, ovarian, uterine, prostate and pancreatic cancers (Wynder et al., 1991). The same dietary changes are thought to be responsible for steadily rising rates of non-insulin-dependent diabetes mellitus among Tokyo school children (Kitagawa et al., 1998). It is also evident that diet is a key factor in the development of heart disease in both Japan and the US (Kashihara et al., 2000), and that the rates of coronary heart disease in the US and Japan may be less dissimilar than previously thought (Saito et al., 2000). A further concern is that while eating disorders among Japanese women are lower than in the US (Nakamura et al., 1999a; Nakamura et al., 2000), young women in Japan may be increasingly at high risk of eating disorders due to rising rates of dieting, restrictive eating and distorted body images (Kiriike et al., 1998).
The Fetal Origins Hypothesis suggests that metabolic efficiencies that developed in response to fetal undernutrition may in turn lead to maladaptive responses under conditions of adult overnutrition, including abnormal lipid profiles, altered glucose and insulin metabolism, and obesity (Popkin, 2001b). Given widespread malnutrition in Japan during the 1940s and 1950s (Matsumura, 2001), this theory also may help explain changing rates of chronic disease among the aging population of Japan. Even so, unless corrective steps are taken in relation to current and future nutrition habits (both under- and overnutrition), it seems likely that both Japan and the US may continue to progress through the nutrition transition with increasingly negative consequences.
Implications for intervention
Individual motivations for eating, as influenced by unique national cultures, may be an important, largely unexplored variable that contributes substantially to the nutrition transition. Support for the argument that personal differences in motivation for eating arise from cultural influences is provided by research showing that the proportion of obesity among Japanese-American men increases the longer they reside in the US (Lauderdale and Rathouz, 2000), Asian university students eat more fats, sweets and fast food after going to the US (Pan et al., 1999), and succeeding generations of Japanese-American women experience increasingly ‘westernized’ diets (Kudo et al., 2000).
As noted previously, food consumption in the US is more likely to be related to ‘health’ objectives (most notably the pursuit of thinness) than in many other nations, including Japan (Rozin et al., 1999). This cultural orientation is in part created by media that intentionally alters the perception of food from one of satisfying nutrition to that of drug-like medication. Low-calorie rice crackers are advertised as a medicine for thinness, while chocolate ice cream is sold as a useful drug for relieving negative emotional states. Due to this health-focused perception, the loss of a physical, nutrition-based relationship with food may become an independent risk factor for progressing through the nutrition transition more quickly, to a greater degree, and with more negative results. In support of this position, it was found in this study that Americans (especially women) were more likely to eat for emotional reasons, and less likely to eat in response to physical promptings. Indeed, acculturation to western nutritional norms seems to predict a stronger link between emotional eating and the emergence of eating disorders (Waller and Matoba, 1999).
The food-culture environment in Japan, on the other hand, may currently offer some protection (Waller and Matoba, 1999). In this study, for example, the Japanese were more likely to eat for environmental reasons, with environmental eating being culturally associated with the spontaneous selection of diverse foods that are eaten to satisfy nutritional needs (Pan et al., 1999). The Japanese also tend to eat more for physical motivations, take more pleasure in eating, and be less concerned with using food to meet ‘health’ objectives (Rozin et al., 1999). The cultural environment that produces these motivations for eating may be one reason that the Japanese currently have diets that are healthier than those in the US. At the same time, things may be changing in Japan as the emergence of body image distortions, excessive dieting, childhood obesity and other ‘western’ patterns may lead to a culture similar to that in the US, where food becomes a health and beauty tool (or emotional medication) rather than a source of nutritional satisfaction.
The limitations of this study are characteristic of any research conducted on a convenience sample of college students. Specifically, the results cannot be extrapolated to include the general populations of the US and Japan. The lack of data collection on more demographic variables, such as the socio-economic status of participants, further limits the interpretation of the study findings.
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CONCLUSION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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As future public health policies and health promotion interventions are designed to address the negative aspects of the ongoing nutrition transition, greater consideration of the cultural environment may be warranted. Specifically, efforts to promote a food culture that is focused on nutritional appreciation, as opposed to one that focuses on food as a health remedy, may be a key factor in the success of developing individual motivations for eating that are based on physical and nutritional needs.
Toward this end, it has been suggested that future public health efforts might include education programs, regulatory strategies, economic incentives and environmental supports that promote positive nutritional environments (Flegal, 1999; Koplan and Dietz, 1999; Jacobson and Brownell, 2000; Nestle and Jacobson, 2000). Such an approach in South Korea has helped shape the nutrition transition in ways that have minimized some negative consequences that are being experienced by other transitional countries (Kim et al., 2000).
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