A qualitative exploration of ultra-processed foods consumption and eating out behaviours in an Indonesian urban food environment.

Background: Increased consumption of ultra-processed foods and drinks high in unhealthy fats, salt and sugar is a major driver behind rising non-communicable disease rates in Asia-Pacific. Urban residence is considered a risk factor for increased consumption of these products; yet, evidence on consumption behaviours and drivers from urban populations in the region remains limited. Aim: To understand perceptions and drivers of unhealthy fats, salt and sugar foods and drinks consumption and eating out behaviours in Yogyakarta city, Indonesia. Methods: In-depth qualitative data were collected through open-ended interviews and prolonged interactions in the local food environment, from a purposeful sample (N = 45) equally distributed across three urban communities. Data were analysed according to the principles of content analysis and following an iterative approach. Results: Despite showing high nutritional health awareness, respondents and their household members consumed ultra-processed foods high in unhealthy fats, salt and sugar regularly. Home consumption of these products was based primarily on economic considerations and convenience, but also related to attending requests from other family members, individual preferences and tastes, and social functions. Similarly, despite a reported preference for home-cooked traditional foods, several participants or their family members would frequently eat ready-made meals away from home, due to conflicting school or work commitments. Discussion: Results suggest that public health interventions focused on nutrition education among Indonesian communities should be coupled with measures addressing urban food environment characteristics that promote the consumption of unhealthy diets, be tailored to specific age groups, and leverage traditional food cultures.

Dietary health perceptions and sources of nutritional knowledge in an urban food environment: a qualitative study from Indonesia.

OBJECTIVE: To investigate dietary health understandings, healthy foods access perceptions and the main sources of nutritional knowledge of residents in three urban communities of varying socio-economic make-up. DESIGN: An ethnographic approach to primary qualitative data collection, involving frequent visits to study areas over 4 months and in-depth interviews. Interviews were recorded, transcribed verbatim and analysed through an iterative approach. SETTING: Yogyakarta, Indonesia. PARTICIPANTS: A purposive sample of 45 participants divided equally among the 3 communities. Participants were mostly female (93 %), aged between 27 and 75 years (mean 47·7) and largely identified as the person responsible for household food-related decisions (93 %). RESULTS: Three overarching themes emerged: (i) dietary health understandings; (ii) healthy foods access perceptions and (iii) sources of nutritional knowledge. Participants employed multifaceted conceptualisation of dietary health. Most identified healthy foods with traditional plant-based foods, inexpensive and locally available from multiple sources. Thus, all participants perceived healthy foods as highly available in the local environment and most (80 %) as affordable. Reported affordability issues referred to specific foods (particularly animal source products) and were independent of income levels. Participants acquired nutritional knowledge from multiple sources, including many community-based initiatives. These were overall perceived as useful, but also as presenting some limitations. CONCLUSIONS: The variety in dietary health understandings reported by study participants, and their high perceptions of healthy foods availability in the local environment reinforce the idea that individual- and food environment-level determinants of nutritional behaviours are highly contextual.

Does urbanisation lead to unhealthy diets? Longitudinal evidence from Indonesia.

Urbanization is generally believed to contribute to dietary patterns that increase the risk of non-communicable disease (NCD). However, empirical evidence using nuanced measures of urbanization and longitudinal data is limited. This study examines the link between urbanization and dietary patterns in Indonesia, the largest country in Southeast Asia, between 2000 and 2015. Results show that urbanisation is associated with dietary patterns conducive to increased NCD risk-for example, high in soft drinks and ultra-processed foods-but also with higher consumption of healthier foods such as vegetables and fish. Results highlight important non-linearities and draw attention to the need to refrain from generalizations about the effect of urbanization on nutritional health.

Weight stigma among adolescents in three low- and middle-income countries.

Background: Overweight (OW) and obesity affect millions of adolescents worldwide. Evidence from high-income countries indicates widespread weight stigma that adversely affects young people's mental and physical health. However, evidence relating to low- and middle-income countries (LMICs) is sparse. We aimed to generate insight into weight stigma prevalence and experience among adolescents in three LMICs. Methods: We identified adolescents aged 15-19 from Brazil, South Africa, and Indonesia from families within market research databases. We adopted a mixed-methods design. The sample included equal numbers by country, sex, and age, and included urban and rural dwellers. Self-reported weight was recorded but was not a selection criterion. Consent (age >18) and assent/parental consent (

Urbanisation, dietary change and traditional food practices in Indonesia: A longitudinal analysis.

The nutrition transition hypothesis poses that as low-and-middle-income countries (LMICs) become wealthier and more urbanised, they experience a shift in dietary consumption towards 'Western' diets high in sugars, fats, animal-source foods, processed and packaged products. This paper uses panel data covering a period of 23 years to examine how changes in the urban environment relate to food expenditures, dietary diversity and traditional practices (food self-production and sharing) in Indonesia, a country that has experienced rapid economic growth and urbanisation over the last few decades. We first examine trends separately for urban and rural areas, and then use fixed effect models to examine whether change in urban residence is associated with changes in food expenditures, traditional practices, and overall dietary diversity. Results show that, despite some increases in acquisitions of animal-source foods and of packaged and ready-made foods, budget allocations for other food groups has remained constant, and that changes have largely occurred in parallel across urban and rural areas. In turn, traditional diets high in cereal and plant products, as well as traditional food practices continue to be dominant in both rural and urban areas, despite the context of rapid socio-economic change and urbanisation. Fixed effect regression suggests that transition from rural to urban residence is not significantly associated with changes in food expenditures for any of the outcomes examined. On the other hand, there is some evidence that moving specifically to Jakarta is associated with some change towards 'Western' food preferences.