Complexity of nutritional behavior: Capturing and depicting its interrelated factors in a cause-effect model

Figures & data

Table 1. Instruments Applied to Capture and Depict Factors of Nutritional Behavior in Their Interrelatedness in a Cause-Effect Model.

	To capture factors of nutritional behavior	To capture direct causal relationships in a cross-impact matrix	To depict cause-effect model
Nutrition-ecological modeling + ST	X		X
Sensitivity model	X	X
Cross-impact balance analysis	X	X

Table 2. Experts Who Participated in the Workshop on Factors of Nutritional Behavior.

Dr. Erika Claupein, Department of Nutritional Behavior, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany

Dr. Anke Hanssen-Doose, Institute of Physical Education and Sports, University of Education Karlsruhe, Germany

Dr. Thorsten Heuer, Department of Nutritional Behavior, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany

Alexander Hose, Dr. von Hauner Children’s Hospital, Ludwig Maximilian University, Munich, Germany

Dr. Cornelie Pfau, Department of Nutritional Behavior, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany

Prof. Dr. Pirjo Schack, Faculty of Oecotrophologie (Home Economics and Nutrition Science), Münster University of Applied Sciences, Germany

Corinna Willhöft, Department of Nutritional Behavior, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany

Table 3. Experts Who Were Interviewed Concerning Direct Causal Relationships between the Factors of the Complex Phenomenon of Nutritional Behavior.

Dr. Erika Claupein, Department of Nutritional Behavior, Max Rubner-Institut, Federal Research Institute of Nutrition and Food, Karlsruhe, Germany

Prof. Dr. Reinhard Fuchs, Institute of Sport and Sport Science, University of Freiburg, Germany

Prof. Dr. Angela Häußler, Department of Social Sciences, University of Education Heidelberg, Germany

Dr. Anke Hanssen-Doose, Institute of Physical Education and Sports, University of Education Karlsruhe, Germany

Dr. Sabrina Hense, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany

Prof. Dr. Christoph Klotter, Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Germany

Prof. Dr. Ingrid-Ute Leonhäuser, Institute of Nutritional Sciences, Justus-Liebig-University Giessen, Germany

Prof. Dr. Uta Meier-Gräwe, Department of Household Science, Justus-Liebig-University Giessen, Germany

Prof. Dr. Barbara Methfessel, Department of Social Sciences, University of Education Heidelberg, Germany

PD Dr. Anke Möser, ConsumerTrail, Gemünden, Germany

Dr. Gesa Schönberger, Dr. Rainer Wild-Stiftung, Foundation for Healthy Nutrition, Heidelberg, Germany

Table 4. Description and Statuses of the 19 Factors Identified for the Cause-Effect Model of Nutritional Behavior (in Alphabetical Order, Based on Expert Statements and the Cited References).

Factors	Statuses
The four main agents of socialization, following Hölscher (2008), are separate factors in the model: family, peers/peer groups, school/kindergarten, and media. The factors relate to the way agents of socialization influence peoples’ thinking and acting. As education is inducing learning with intent (Prahl and Setzwein 1999), this aspect is included in the factor. The influence of the agents of socialization leads to a process of socialization. According to Hölscher (2008), this is a lifelong, permanent, and fluent process.	Favorable for one’s health, unfavorable for one’s health
Food availability (private) refers to the availability of foods; for example, in private households (among others dependent on storage facilities and possible own gardening), at workplaces, in the bag away from home, and at kindergartens where children have free access to the present food. It is related to quantity and quality of the available food, meaning that diversity and amount are of relevance.	Good, poor
Food consumption refers to usual food consumption instead of consumption on a certain day. It is related to the kind and amount of foods being consumed and not related to where, when, and with whom food consumption takes place. The factor includes purchase decisions and therefore market demands.	Favorable for one’s health, unfavorable for one’s health
Food supply aggregates food offered in food stores and food offered for out-of-home consumption (e.g., restaurants, cafeterias). It is related to quantity and quality of the offered food, meaning that diversity and amount are of relevance. The factor also includes prices and access to food (i.e., infrastructure: choice of food stores and offers for out-of-home consumption as well as distances, accessibility (e.g., by car, bike, foot), and opening hours of food stores and places for out-of-home consumption).	Good, poor
Hunger/thirst/appetite aggregates hunger, thirst, and appetite. Instead of a current state, which changes frequently throughout the day, the factor refers to a more fundamental state.	A lot, little
Nutrition competences aggregates a person’s knowledge, experiences, as well as mental and physical ability and skills related to nutrition. Handling of knowledge and adequate implementation are also included in the factor (BMBF 1998; Eberle et al. 2005).	Existing, missing
The different phases of life are classified by chronological age as well as according to Schienkiewitz and Walter (2003) by biographical, biological, cultural, social, and subjective aspects.	Childhood, adolescence, adulthood, senior age
Physical activity refers to movements induced by skeletal muscles that increase energy expenditure (Mensink 2003) and not only to sports.	Sufficient, insufficient
Psychological resources aggregates self-efficacy and emotional control (handling of emotions, especially stress).	Existing, missing
Sex/gender aggregates the biological and the socially constructed sex/gender. Examples for aspects characterizing sex/gender of a person are stereotypes like norms of beauty and concerns about the body (Methfessel 2004), symbolism of food (e.g., meat as a male food) (Prahl and Setzwein 1999), and energy requirement.	Female, male
Sleep duration relates to the habitual time spent asleep (according to the definition by Grandner et al. 2010). Time being awake in bed is not included.	Habitually optimal, habitually deviating from optimal
Smoking relates to physiological effects of smoking.	Yes, no
Social identity refers to the current state of the process of socialization in relation to nutrition and health. Aspects characterizing the social identity of a person are values and norms (Hölscher 2008). These include restrictions of food consumption (Prahl and Setzwein 1999), ideals, rituals, symbols, traditions, habits, and customs. The factor includes attitudes towards food (e.g., interest in and appreciation of nutrition) as well as importance of eating, drinking, and food. The latter is also linked to the willingness of spending money for nutrition. Furthermore, awareness of sustainability and health is included.	Favorable for one’s health, unfavorable for one’s health
Socioeconomic status aggregates occupation (or professional reputation), education, and income of a person (Springer Gabler Verlag n.d.). The factor relates to the availability of money/resources and whether somebody is employed, unemployed, going to school, or undergoing an apprenticeship.	High, low
State of health is based on the definition of health by the WHO: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO 1946, pg. 2). However, this factor aggregates physical and mental well-being only.	Good, poor
Time spent for nutrition aggregates time spent for nutrition-related work of a private household and time spent for eating. Time spent for nutrition-related work includes aspects like cooking, shopping, stock-keeping, and other nutrition-related housework. Time spent by all household members (i.e., of the cook within a family and of the people cooked for) is accumulated.	Extensive and regularly, shortly and infrequently

Figure 1. Cause-effect model of nutritional behavior. A (top): Strong and medium causal relationships. B (bottom): Weak causal relationships. For reasons of clarity, factors are sorted according to topics.

Table 5. Examples for Models (and One Database) of Overall Nutritional Behavior and of Specific Aspects of Nutritional Behavior That Include Strength and/or Type of the Relationships between Factors and/or the Interplay of the Direct Relationships (i.e., Cause-Effect Chains, Feedback Loops, Multicausalities, and Side Effects).

Source	Focus of the model	Strength of relation-ships	Type of relation-ships^1	Cause-effect chains	Feedback loops	Multicausalities	Side effects
Presented model	Overall nutritional behavior	X	X	X	X	X	X
Model from literature focusing on overall nutritional behavior
Bodenstedt et al. (1985)	Overall nutritional behavior			X	X	X	X
Database from literature focusing on overall nutritional behavior
Booth et al. (2001)	Overall nutritional behavior	X^2				X
Models from literature focusing on specific aspects of nutritional behavior
Baranowski et al. (2008)	Home fruit and vegetable availability and consumption			X	X^3	X	X
Drewnowski and Eichelsdoerfer (2009)	Consumer food choice comparing Western and Mediterranean diets	X^4		X		X
Fisher and Birch (2000)	Snack foods	X	X	X			X
Krebs-Smith and Kantor (2001)^5	Food choice			X	X^3	X	X
Rose et al. (2010)	consumer choice and food purchases			X		X
Sandvik et al. (2010)	Fruit intake	X	X	X		X	X
Schwarzer and Renner (2000)	Low-fat and high-fiber diet	X	X	X	X	X	X
Sharkey, Horel, and Dean (2010)	Food access			X	X^6	X	X
Shepherd (1985)	Food choice and intake			X		X	X
Sims, Paolucci, and Morris (1972)	Nutritional status			X		X
Wang, Worsley, and Cunningham (2008)	Consumption of healthy foods (e.g., vegetables, fruits) and unhealthy foods (e.g., sugar, fats)	X	X	X	X	X	X
Westenhöfer and Pudel (1989)	Bulimia nervosa		X^7	X	X	X	X

Note. ¹Promoting or restricting.

²Expert statements concerning the strength on a 3-point scale (low, medium, high).

³Model includes one feedback loop only.

⁴The importance of the factors is indicated by their size depicted in the model.

⁵Adapted from a model by Life Science Research Office-Federation of American Societies for Experimental Biology (1989).

⁶Model includes one feedback loop only. More feedback loops are implied as the shown feedback loop is a bidirectional relationship between two factors with many enlisted subfactors.

⁷In this model, types of relationships are roughly indicated by the specification “reinforcement” or “reduction”.

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