Balanced Diet And Daily Calorie Consumption: Consumer Attitude During The COVID-19 Pandemic From An Emerging Economy

Abstract

The effects of the COVID-19 pandemic on consumer attitudes about a healthy diet and daily calorie intake were effectively evaluated using beliefs, affection, and intentions. The repercussions for the government and business community were discussed. This study also evaluates the usefulness of the tri-component attitude model in the Indian context.

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1. Introduction 

Consuming a balanced diet is an ardent task for most people in the world. Due to recurring diseases like COVID-19, Ebola, and Swine flu, and chronic diseases like diabetes, hypertension, thyroid, etc., it has been increasingly necessary to improve people’s immunity. Immunity helps to fight these diseases and other ailments such as blood pressure, diabetes, thyroid, etc. Immunity can be increased by consuming a balanced diet and monitoring daily calorie consumption [1]. The impact of COVID-19 has shaken the world to its roots—globally, more than 165 million people have been infected, and there have been more than 3 million deaths as of this time [2]. More than 43 million people have been infected in India with over 521,000 deaths reported [2]. The everyday lives of people are disturbed through, for example, the closure of public places like malls, gardens, cinema theatres, etc., in order to curb the spread of COVID-19. In this challenging situation, it is necessary to maintain health and improve immunity. In order to boost immunity in quarantined patients in India, properly balanced diets are provided to aid in fighting COVID-19 in addition to treatments and vaccines. Such is the effect of this pandemic that the economic growth rate of many countries has declined, and many people, globally, have lost their jobs and enterprises have ceased trading.

58 percent of the 57 million annual deaths in the world are estimated to be due to Non-Communicable Diseases (NCD); mostly related to the heart, chronic pulmonary disease, cancer, and diabetes [3]. A poor intake of fruit and vegetables, high blood pressure, high blood cholesterol levels, overweight or obesity, physical inactivity, and nicotine use are the most significant risk factors for NCD. In the next few decades, population growth and aging are expected to significantly increase in conjunction with economic transformation and resulting shifts in jobs, and environmental risk factors [4]. People suffering from the aforementioned diseases and older people are among the most vulnerable to recurring diseases like COVID-19, Ebola, etc. COVID-19 was declared a global pandemic by the World Health Organization (WHO) in 2020.

The likelihood of death due to COVID-19 is high if people already have non-communicable diseases [5]. In a developing country such as India, the risk of COVID-19 is very high. However proper consumption of a balanced diet and monitoring daily calorie intake [6] are a necessity in times of a pandemic. According to Lancet, the average Indian (urban or rural) consumes a higher amount of carbohydrates in the form of cereals (Fig 1) than The Lancet Commission [7] recommends. Whereas the protein consumed is significantly less than recommended by the average Indian, the daily calorie intake in both rural (2214 kcal) and urban (2169 kcal) India is less than the reference diet (2,503 kcal/capita/day), except for the wealthiest 5 percent of the population [8].

In addition, there is less fruit and vegetable intake by Indians and too little unsaturated oil consumption (Fig 2). With an emphasis on natural products over packaged food, a diverse diet was recommended by the EAT-Lancet committee [7].

Fig 1. Daily calorie intake. Source: [7]. �Quantities not mentioned for some categories as data for some individual components was in terms of number of packets/cups etc.

A population must have sound knowledge and a positive attitude toward a balanced diet and daily calorie consumption [9]. This study investigated the declarative knowledge and consumer attitude toward a balanced diet and monitoring daily calorie intake among the working population in India by using a tri-component attitude model during the COVID-19 pandemic.

2. Review of literature

Nutritional guidelines were announced during the COVID-19 epidemic emphasizing the importance of a balanced diet to sustain a well-functioning immune system and prevent or reduce chronic diseases and infections. Dietary guidelines from WHO during the COVID-19 pandemic are comparatively higher than the standard dietary recommendations by the WHO [10]. Literature shows clear evidence of an inadequate diet and the risk to the health thereof [11]. Research from Boylan that linked a poor diet and a lack of physical activities together with the risk of obesity has helped create and promote recommendations to increase public health [11]. Over-consumption, lifestyle, accessibility to food, and strong pressure exerted by the foodstuff industry have disrupted all elements of food consumers’ behavior which have caused them to lose out on nutritious milestones that have been achieved by family education [12, 13]. Consumers are not initially looking for seasonal foods, but for what seems to be the most favorable value for money. In this sense, more than ever, the need for knowledge to connect nutrition and well-being, to avoid nutritional and metabolic disorders, and the need for the fundamental values of a healthy diet to mainly be adopted by a new generation of customers. They have positive expectations of quality of life and a special perception of well-being factors. Limitations brought about by the pandemic, particularly, voluntary and involuntary online studying, have an essential impact on lifestyle and health conditions and became an important feature of well-being. Health is understood to depend on diet to a large extent [14]. Many authors have stressed the importance of a balanced diet and daily calorie consumption in daily life [15]. Also, experiments have shown that a balanced diet helps to reduce weight among obese people [16]. Nutritional education among consumers helps increase awareness about a balanced diet and daily calorie intake [17].

Knowledge does not consist of a single structure but different components. JR Anderson first identified two elements of knowledge. One represents ‘to know’ and the other represents ‘to know how’. These principles are applied to the concepts of procedural and declarative knowledge in cognitive psychology. Knowledge of facts and objects is called declarative knowledge, while knowledge of performing actions is procedural knowledge [18]. Procedural knowledge is also closer to behavior. These differences in declarative and procedural knowledge are extended to the nutrition domain [19]. Few studies have evaluated declarative knowledge [20, 21]. In contrast, some have included concerns about procedural knowledge, typically in the form of food options or by posing a query [22–24]. Declarative knowledge among the population can be ascertained through the study of consumer attitudes toward a balanced diet and daily calorie consumption. Consumer attitudes and perceptions play an important part in the dietary behavior of an individual. Attitude plays a key role in forecasting behavior, and persuasive communications are undertaken to help people partake in healthy behavior. Most diet awareness initiatives for subpopulations such as cardiac patients [22], adolescents [23], or young men [25] are planned and applied.

2.1 Tri-Component attitude model 

Psychologists have come up with models and theories that help understand consumer attitudes; these assist in understanding consumer buying behavior [26, 27]. Important models or theories of consumer attitudes discussed in the literature include the theory of planned behavior, the tri-component attitude model, the hierarchy of effects model, the theory of reasoned action, and the attitude toward behavior model. This model, regarding components of attitude and their relationships, provides varying perspectives. The tri-component attitude model is the fundamental model to study the attitude of consumers developed by [27]. The tri-component attitude model (Fig 3) has three constructs: viz, cognition, affect, and conation [28] as shown in Fig 1. Arnould [29] proposed that this model is labeled as the ABC model, with affection, beliefs, and conation as rearranged components. Cognition (understanding) of a person is the consumer’s perceptions and knowledge through understanding the related item and facts from several sources [28, 30]. 

The conative component, the way the attitude we have influenced how we act or behave, describes the intention to buy or follow, which is also known as behavioral intention. Some explanations consider conation as the behavior itself [28]. However, Assael [30] conflicts with this view. He asserts that the beliefs and assessments of a specific item sometimes need not change the intention of consumers to purchase or follow, especially if economic incentives are sufficient; such as a sharp price decrease. In developing a marketing strategy [31], it is essential to measure behavioral intention. Studies have been carried out regarding dietary behavior during normal times but such studies during the COVID-19 pandemic have not been carried out. For instance, Popescu and co-authors undertook exploratory research based on the methodology of the food diary by evaluating the features of Romanian food consumption for the next decade. Investigators analyzed the respondent’s diet’s medium energy use and macronutrients to identify possible dietary imbalances [13]. Consumers’ healthy eating choices are strongly linked to epistemic and emotional values [32].

In Mexico, Carrete researched the perception of drivers and inhibitors of sound dietary behaviors, with attention paid to serious problems with obesity [33]. The theoretical basis for this research was the theory of planned behavior (TPB) and protection motivation theory (PMT). Results show that poor self-efficacy and high costs inhibit behavioral change [33]. Sanusi studied the dietary behavior of university students and noticed that attitudes toward behavior were found to be the more influential predictor of intention to use dietary guidelines in Malaysia [34]. Worsley concluded that nutritional knowledge is a necessary factor in improving customer behavior, but it is not adequate. For nutritional promoters, the interplay of motivational and information-processing factors and the distinction between declaratory and procedural knowledge is essential [19, 35]. Additionally, research on monitoring daily calorie intake has shown positive results. Alamer found that customers who checked their daily calorie intake were more likely to change their attitude toward eating behavior [36]. Researchers have used cognitive, affective, and conative components of consumer attitudes to study dietary behavior in the literature in normal times. For example, Sijtsema [37] examined the nature, structure, and use of projective approaches in cognitive and affective terms (expressive and associative) to discover consumers’ health perceptions. They observed that participants associated healthy living with feeling comfortable and satisfied and found an equilibrium between being active and passive [37]. Dietary education is related to maximum scores for food knowledge in developed countries [38].

Fig 3. Tri-component attitude model. (Source: [28]). 

The consumer’s attitude was not assessed coherently despite its significance in marketing. For evaluating the dimensionality, reliability, and validity of customer attitudes to imported poultry products, Makanyeza measured the assessment of consumer attitudes based on a tri-component attitude model [39]. The study showed that the customer approach to poultry products has 3 constructs: viz., cognition, emotions, and purchase intentions [39]. In consumer health habits, Makarem studied emotion and cognition. He found that wellness programs aimed at improving treatment compliance should consider alternatives to messages demanding control over patients’ health [40]. In national surveys of a member state of the European Union, Authors studied the attitudes of adult individuals to nutrition, food, and health. Most EU customers do not think they need to change their diets because they believe they are safe enough (Erdeine´ Ke´sma´rki-Gally and Fenyvesi, 2012). For certain classes of the population, prices may play a large part in choosing food in Europe as in other developed and developing regions. Therefore, the issue with nutritious food proponents in the EU may not be a lack of awareness, but rather of the nature of diet recommendations [41].

On the other hand, in Asia, dietary behavior is influenced by Western culture. Authors observed that Koreans preferred Westernized and unbalanced foods, providing fewer nutrients [42]. It was underlined that the growing demand for Western-type foodstuffs can be the implication of the general popularity of the American lifestyle in South Korea. Moreover, the increasing income of family households—especially in the younger generation—generated a demand for food products that used to be almost unknown in the traditional Korean diet. The Korean Medical Association issued 3 top methods for a safe and healthy diet in 2017 to reverse this unfavorable cycle. These recommendations were intended to enable the population to consume a healthy diet that matches the prescribed intake of calories and reduces the threat of obesity as well as diseases associated with an unhealthy diet. Avoiding over-eating and being physically active at a young age can help reduce these conditions [42]. Whilst a balanced diet should be followed by consuming a range of foods, the ideal is different from what people consume. Food is rich in nutrients, including food supplements and fortified foods, and may be used as a powerful means to guarantee micronutrient satisfaction in persons at all phases of life and with shifting lifestyles, where food selection can incorporate an optimal diet [43].

Thomas examined the connection between food preferences and the understanding of a balanced diet of primary school students. There was so significant connection between the pupils’ diet selection and their knowledge of a balanced diet. The findings revealed that children make ’good decisions’ but need the awareness behind these healthy choices to change their approach to a balanced diet [44]. Casini and co-authors analyzed the development of dietary habits in Generation X. The findings indicate that dietary lifestyles with high animal protein content are strengthened, especially for consumers with poor educational levels. Convenience foods become essential, particularly for couples and for families with children. The significance of consumption at home, mainly among individual men, is increasing [45]. The food industry should ensure that the messages it has created are inspiring and meaningful for consumers’ lives through ongoing dialog with its consumers and studies on consumer knowledge and dietary attitudes [46].

For urban American youth, Fila studied their healthy eating behavior. He found no association between healthy eating and intentions. A balanced food supply and taste were the most predictive obstacles. The behavior of boys was predetermined by subjective norms, while the behavior of girls by obstacles is more expected. Results show that healthier eating activities should concentrate on working with families to make healthy food attractive for young people [47]. Song classified products that consumers think are safe and harmful and examined how these products affect consumers’ attitudes [48].

Research findings demonstrate there is a difference between product appeal dependent on outstanding sensory properties shown by young customers and the actual dietary content of products, transforming into unbalanced nutrient profiles in packed food. Research results show that young customers need to be reassured that delicious food is not always nutritious and to have proper nutrition and a healthy way of life is of value. Young people should be better trained in dietary methods, weight control, and fitness [49]. It is found that consumers perceive functional foods help them follow a balanced diet but are anxious about labels communicating the health benefits [50].

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