Understanding the food-family relationship: A qualitative research in a Chilean low socioeconomic context

Abstract

Our life is comprised of, among other things, many food and eating decisions. Therefore, we are in a constant relationship with food. Although many health providers and researchers have recommended having a positive relationship with food for better health and well-being, what the human relationship with food entails is still unclear. The aim of this study is to explore the relationship with food among families in Chile, a country that has the highest rate of obesity among OECD countries. In this qualitative study, we conducted eight focus groups in three regions of Chile (North, Center, and South). We recruited women living with their partners and children who represented the family point of view. For data analysis, we used the Atlas.ti program and conducted a thematic analysis. We found that the family relationship with food had five dimensions: (1) An identity dimension that allowed families to describe themselves or some of their family members; (2) an emotional dimension in which family expressed feelings and emotions through food; (3) a social dimension in which family members got together through food; (4) a health dimension in which family related to food to obtain benefits from it or to avoid enemy food; (5) a practical dimension in which families were organized around food tasks. Our findings show that the relationship that Chilean families have with food is a complex phenomenon. All the dimensions should be taken in consideration to create or improve interventions that seek to improve eating habits or prevent nutrition-related diseases from a family perspective.

Introduction

Food plays a central role in our lives. Eating is one of the most important activities we experience daily (Delormier, Frohlich, & Potvin, 2009; Kauppinen-Räisänen, Gummerus, & Lehtola, 2013; Macdonald, Murphy, & Elliott, 2018). Eating is not only a way to satisfy our needs for nutrients and energy; it is also a way to connect with others, in a social and cultural manner (Antin & Hunt, 2012; Ma, 2015; O'Kane, 2016; Sobreira, Garavello, & Nardoto, 2018). Furthermore, we make more than 200 conscious or unconscious decisions related to food daily (Wansink & Sobal, 2007). Ultimately, eating is linked to our relationship with food, and since this relationship is linked to social and cultural connections, it is certainly motivated by more than hunger.

Block et al. (2011) introduced the term “food well-being,” which means “a positive psychological, physical, emotional, and social relationship with food at both the individual and societal levels” (p. 6). In a world where the prevalence of nutrition-related diseases is increasing (Schulze, Martínez-González, Fung, Lichtenstein, & Forouhi, 2018; World Cancer Research Fund International & The NCD Alliance, n.d.), it is necessary to understand the implications of this relationship with food.

For Bulblitz et al. (2011), the relationship with food is essential for food well-being. It has been recommended that people should have a positive relationship with food for better health and well-being (Bauer, 1993). Furthermore, this relationship with food has been linked to food literacy and other factors, such as social, cultural, economic, and family-related as well as emotional, physical and psychological traits (Bulblitz et al., 2011). But, what does this relationship with food mean?

From an individual and a customer point of view, the human relationship with food has been described as multidimensional (Bulblitz et al., 2011; Fischler, 1988). For Fischler (1988), this relationship includes two dimensions with mixed elements: The first dimension ranges from the biological (nutritional function) to the cultural (symbolic function), while the second dimension ranges from the individual (psychological elements) to the collective (the social elements). Although the author does not describe these dimensions in detail, previous researchers have attempted to understand their elements. For instance, from an individual biological perspective, food has been commonly used as a way to obtain health benefits since it allows people to be free of illness; therefore, food could be used as part of the treatment of certain conditions or as a way of preventing them (Backett-milburn, Wills, & Roberts, 2010; Nyberg et al., 2018). On the other hand, from a cultural perspective, “food and eating focus on social values, meanings, and beliefs rather than on dietary requirements and nutritional values” (Murcott, 1982, p. 203). Culture dictates what individuals in that culture should be eating or cooking and what they should not, and as a result, it shapes people's relationship with food (de Garine, 1972; Gálvez Espinoza, Egaña, Masferrer, & Cerda, 2017).

Additionally, from a psychological perspective, emotional eating has called the attention of several researchers: overeating to overcome negative emotions has been widely published (Adam & Epel, 2007; Kemp, Bui, & Grier, 2013; Strien et al., 2013), whereas other studies have been conducted to demonstrate the relationship between positive emotion and food intake (Evers, Adriaanse, de Ridder, & de Witt Huberts, 2013). From a social perspective, food and eating represent a symbol of socialization and are closely related to the concepts of union, conflict, and social behavior (Coveney, 2002; Delaney & McCarthy, 2014; Neely, Walton, & Stephens, 2014).

While all the aforementioned research intends to shed light on the various elements present in the relationship of people with food, these studies mostly describe one dimension only, and they describe it mostly from an individual point of view. As eating behaviors go beyond individual decisions (Gardner et al., 2014), we argue that the relationship with food should be thought of similarly, that is, studied from a collective perspective. A clear definition of what the human relationship with food entails for families—a second level of influences of eating behaviors, according to the socioecological model (Quick et al., 2017)— is necessary to face current nutritional-related health problems.

Therefore, to address this gap, the aim of this qualitative study is to explore the relationship with food among Chilean families from low socioeconomic neighborhoods. Chile is considered a high-income country, with a low rate of poverty (3.7%), but has more than 30% of the population in a vulnerable situation (The World Bank, 2020). Even while Chile has relatively good health indicators, this setting is particularly relevant for the study, as it has been found that Chile has the highest rate of obesity among OECD countries (Organisation for Economic & Development, 2019). Among people over 15 years old, those who are of low socioeconomic status have the highest rate of obesity (Ministeriode Salud. Gobierno de Chile, 2017a). Furthermore, the latest National Eating Survey revealed not only that just 5.3% of the population has a healthy diet, but also that people of low socioeconomic status have less healthy diets than those of other socioeconomic groups (Universidad de Chile, 2012). On the other hand, the family perspective has been selected because it is here where health and disease happen; in addition, it has been demonstrated that well-being is related to the family context (Ross, Mirowsky, & Goldsteen, 1990). The family context is where health notions are learned, lived and experienced, and the place where the members of the family meet and respond to disease through life (Denham, 2003). It is within the family where people first learn eating behaviors and share eating patterns (Savage, Fisher, & Birch, 2007; Suggs, Della Bella, Rangelov, & Marques-Vidal, 2018). For Gillespie and Johnson-Askew (2009), “[a] family unit shares its own history of interactions with and about food, health, eating, and family role structures and patterns” (p. 4). Further, family has been recognized as a key element in several food guidelines (Ministeriode Salud. Gobierno de Chile, 2017b; Ministry of Health of Brazil, 2014; U.S. Department of Agriculture, n.d.). In previous research that we conducted in Chilean women of low socioeconomic status, family was highlighted as an important influence on eating behaviors (Galvez E et al., 2017; Galvez Espinoza et al., 2018; Vizcarra et al., 2019). Therefore, the relationship that family has with food could contribute to shaping family members’ eating behaviors. Understanding this relationship could ultimately contribute to designing more family interventions that focus on promoting healthy eating, especially in people of low socioeconomic status who have the highest rate of obesity in Chile.