Cultural Influences on the Regulation of Energy Intake and Obesity: A Qualitative Study Comparing Food Customs and Attitudes to Eating in Adults from France and the United States.

ABSTRACT

(1) Background: The influence of food culture on eating behavior and obesity risk is poorly understood. (2) Methods: In this qualitative study, 25 adults in France with or without overweight/obesity participated in semi-structured interviews (n = 10) or focus groups (n = 15) to examine attitudes to food consumption and external pressures that influence eating behavior and weight management. Results were compared to an equivalent study conducted in the United States, thereby contrasting two countries with markedly different rates of obesity. Emerging key themes in the French data were identified through coding using a reflexive approach. (3) Results: The main themes identified were (1) influence of commensality, social interactions, and pleasure from eating on eating behavior, (2) having a balanced and holistic approach to nutrition, (3) the role of environmental concerns in food consumption, (4) relationship with "natural" products (idealized) and food processing (demonized), (5) perceptions of weight status and management. Stress and difficulties in hunger cue discernment were viewed as important obstacles to weight management in both countries. External pressures were described as a major factor that explicitly influences food consumption in the U.S., while there was an implicit influence of external pressures through eating-related social interactions in France. In France, products considered "natural" where idealized and juxtaposed against processed and "industrial" products, whereas this was not a salient aspect in the U.S. (4) Conclusions: This first comparative qualitative study assessing aspects of food culture and eating behaviors across countries identifies both common and divergent attitudes to food and eating behavior. Further studies are needed to inform the development of effective behavioral interventions to address obesity in different populations.