A study of perceptions about healthy food advertised in select urban areas in India

Rishika Mathur, Pushkar Phadtare. A study of perceptions about healthy food advertised in select urban areas in India. Cardiom-etry; Issue 20; November 2021; p. 60-69; DOI: 10.18137/cardi-ometry.2021.20.6069; Available from: http://www.cardiometry. net/issues/no20-november-2021/study-perceptions-healthy

“An imbalance in energy intake and expenditure causes the body to accumulate and store unhealthy amounts of fat tissue, leading to obesity. The build-up of excess body fat causes health problems like breathlessness, increased sweating, joint pain, fatigue and may lead to future complications like heart diseases, reproductive problems and several other sorts of cancer.” [1]. Body Mass Index (BMI) is a tool that is used commonly to measure obesity. It is calculated as the “ratio of weight, in kilograms, to height squared, in meters. Adults with a BMI of 25 or higher are classified as overweight, and those classified as obese have a BMI of 30 or more” [1].

Overweight and obesity may be avoided by a careful choice of healthy foods and frequent physical activity. In low revenue and middle-income nations, particularly in metropolitan areas, an issue that has been widespread in countries with high incomes is rising. “In 2014, there was overweight of more than 1,9 billion people (aged 18 and older) and 41 million infants under age 5. Nearly half of the overweight or obese children under the age of five resided in Asia in 2014. “In 1999-2016, the prevalence of obesity among men and women quadrupled and became a new issue.” [2].

Since “very highly-processed, energy-densely lowcost meals and foods have gotten considerably cheaper. People consume caloric, fatty, sweet and savory foods while not eating enough fruits, vegetables, and pulses. Although individual nutritional requirements vary with age, gender, lifestyle, and physical activity, certain general features of a balanced diet for adults are present. The WHO lays out these guidelines. A healthy balance of nutrients, such as protein, carbs, fathers, etc., should be emphasized concerning calorie consumption and diets.

The quality and the amount of protection rely on the amino acid combination and the body’s digestion and use of the protein.

Carbs offer many dietary energies and are primarily used in meals with high fiber vitamins and minerals as unprocessed complex carbohydrates. Simple carbohydrates in foods or beverages should be free to supply a maximum of about 10% of the overall calories. Additional health benefits are provided when free sugar is reduced to less than 5% of the total calorie intake – corresponding to around 25 g or six levels teaspoons of sugar per day for a person with healthy body weight.

Fats (no more than 30 percent of total calories in consumption) should be eaten in moderation, mainly unsaturated fats.

Salt from processed foods should be below 5 grammas daily, including salt.’ 1989.

Food labels “help consumers who want to follow the dietary guidelines and make healthy food choices that best fit their dietary needs by giving information about the product.» In India, FASSI has set specific rules about claims and advertisements that the food business operators have to abide by regarding their food products. Part III, section 4 of Food Safety and Standards (Advertising and Claims) Regulations, 2018 has set definitions and guidelines for nutrition claims, synonyms which may be used for allegations defined in these regulations, health claims, health claims for Fortified Food articles, and use of certain words or phrases in their schedule I, II, III, IV, and V respectively. Certain documents Discussed in the paper «Influence on healthy foods by consumers, the concept of a healthy diet, and personal values» «Healthy eating directives did not have significant links with perceived dietary quality, whereas healthy/unhealthy eating had good impacts on perceived dietary quality because individuals have confidence in a government program for their definitions of healthy eating. They found that healthy eating campaigns, focused on optimizing nutritional values, in particular, cannot successfully promote healthy eating behavior, except in addition to other opinions on healthy eating.»In Findings from [6], a new global ‘FATitudes’ study by American corporation Cargill state that about 70% of the Indian consumers check for fat and oil in packaged food, while globally, the figure stands at 69%. Furthermore, the survey notes that «54 percent indicated that packaged goods with fat-related labels, such as free fat, reduced fat, etc., are more likely to be bought.

Moreover, in most countries, an organic label certification affects purchase decisions more compared to non-GMO checks.» Book titled ‘Conversation about Healthy Eating’ argued that many people don’t think in terms of processed and unprocessed and might not have the right idea about which food are healthy and which are not. People who believe that they are making a healthier choice by picking something labeled «low fat» would not check the actual contents to see if the product has low sugar or not, leads to the point that there are several misunderstandings about which foods are healthy and which aren’t [7].

In a scenario like this, where a potential pandemic of obesity threatens the world and overweight and growing awareness has pushed a few people to pick healthy food, it is essential to understand how healthy food is advertised and subsequently perceived by the consumers.

Review of literature

Research conducted to prove “how the effect is closer to better and less healthy meals if they both are available” revealed that “a healthier food than a lower food, its proximity and that of competing less healthy foods are not substantially influenced.” On the contrary, its closeness has affected the chance of consuming less healthful meals.” [3] ‘The basic case scenario provides for a 4.5 percent drop in total consumption from 80.5 minutes per week to nil in TV food advertising for US kids. In the event of a 4.5 percent lower body weight per 10 percent drop in intake, children will weigh around 2.1 percent below the present average condition results in a 0.38 kg m 2 drop in a mean BMI, with a 2.7 (95% uncertainty interval 2,3–3.1), percentage point decrease in boy prevalence and 2.4 (2.1–2.8) decrease in girl prevalence. There would be a reduction in the proportion of children with overweight.” [4]Junk Consumption of food in both rich and developing economies is a key source of childhood obesity “as a worldwide epidemic. Since childhood obesity typically continues into maturity, the danger of serious health illnesses will grow an increasing number of people.” [11] Past study demonstrates that the perceived quality of consumer diets is “reflective of their dietary behavior,” in which intake of fruits and vegetables is favorably related to eating habits and in which soda and fast food consumption have been negatively affected [13].

A lot has been said about the effects of advertising food directly to young adolescents using channels predominantly viewed by them, and the government has also taken required measures. However, there is limited evidence that appropriate measures are taken to improve the health of adults even though obesity and overweight are a growing concern for the country. A study by [5] et al. concluded that TV channels watched by young adolescents run food-related advertisements that mainly promote salty snacks, candies, sweetened soft drinks, and fast food joints. The median age of

• 15 years is the sample for this investigation. Another study found that “one in seven to one in three obese children in the USA could not be obese unless the advertisement of unhealthy food on the TV were available. The sample for this study was from 6 to 12 years of age”: “High fat and high sugar meals can be considered exploitation by little children as they do not grasp that advertising items are for sale and are not capable of understanding and evaluating advertising.” In the US, teens obtain insufficient daily intake of calcium. A “research revealed that 18% of youth did not consume fruit or veggies every day. Every day, 7 percent ate salty snacks and sweets, and one-third ate them many times a day. Sometimes refined cuisine is announced as a contribution to contemporary living, which typically attracts young people. Such foods frequently include large amounts of fats and sugar, which lead to excessive intake of other foodstuffs. Cooperation between households, health professionals, pedagogues, food producers, and media will assist young people in choosing educated dietary habits.”

“The customer is reported to utilize nutrition labels and claims, but generally the degree of knowledge is quite poor.” In a US research, the possibility of improving customer views regarding the inclusion of a variety of healthier nutrients was discovered via NCCs (Nutrient Content Claim) that “are present on less healthy food goods. At the same time, the existence of NCCs appears to diminish awareness that less healthy characteristics are present. Perceptions of product health than lead to greater intents to replace the one considered by alternative items.” [8].

Existing Theories

“When information is insufficient, heuristics enable people to choose to preserve cognitive and motivational resources.” Another idea is social theories that state that “to alter behavior, it is necessary to have a high degree of self-efficacy. Self-effectiveness has improved via knowledge, practical expertise and social encouragement” [12]. Central vs. peripheral routes to persuasion and the elaboration likelihood model focuses on motivation and ability of the target audience is vital criteria in objective setting. If cause and ability are both high and central processing is more likely, it makes sense to focus on changing attitudes through strong reasons why the brand is better. But if either motivation or ability is low and peripheral processing is more likely, the objective should be to create a pleas- 62 | Cardiometry | Issue 20. November 2021

ant feeling for the brand [15]. When advertisers are in high involvement situations, with the consumers seeking to solve problems or benefit rationally, the overall implication for advertisers is that advertisers should have as their aim a communication of product benefits through message contents, only that can lead to the necessary change in attitude Situations with low participation. However, this should not lead to transmission of attitude-enhanced reasons on why the brand is better than to seek increased awareness as the primary aim. Research has shown that when subjects prefer to economize on time and effort in making a brand choice, they give great weight to the fact that they are previously aware of a brand instead of probing quality differences in detail.

Methodology

The research design adopted for this study is twofold. First, exploratory research is done through a literature review. The second part is a descriptive study using the survey method will be cross-sectional, and the sample will be used, and only one questionnaire will be given to them. As a sample frame is impossible to establish, non-random purposive sampling will be done [14]. There will be a questionnaire for the sample size of 200 within the age range of 10-24. It will be designed to understand the perception of the consumers towards food that claims to be healthy.

Segregation of Food TVCs

The food advertisements on TV will be analyzed and categorized into healthy or unhealthy, based on the labels that are highlighted in the ad. Then the route of persuasion of advertisements of the products that claim to be healthy will be determined and categorized into peripheral and central depending upon the ad’s message and the endorser picked to promote that product in the ad [4]. Heuristic cues will be identified in the advertisements that suggest that the product may be healthy such as ‘low fat, ‘organic,’ ‘natural,’ etc. The nutrient contents will be analyzed to understand the pros and cons of the same. Products advertised will also be categorized based on the image of the parent brand [9].

Questionnaire

According to WHO, a sample of 200 youth (belonging to the age group of 10-24) will be given a questionnaire [10]. The questionnaire will be non-in- teractive, structured, and cross-sectional. It will have two parts:

The first part will require them to fill in personal details such as name, age, height, and weight. The height and weight of the sample will help us calculate their BMI. They will also be asked whether they consider themselves health-conscious or not to establish their perceived dietary quality. They will have to score their eating habits on a scale of 1-10, where one is extremely poor, and 10 is excellent.

In the second part of the questionnaire, they will also be asked to pick up a product from each category as if they were to add it to their shopping cart. Their choices will be followed by a question requiring them to score their product choice by rating it based on the heuristic cues or labels used in advertisements of the products in that category.

The statistical tools to evaluate and interpret the questionnaire results are the chi-square test, regression, and ANOVA.

Hypotheses

With the help of a literature review, the variables to form the theoretical framework of this study were identified. The independent variables to be considered for this research are brand endorsers, labels, and perception of the brand being healthy. The dependent variable is perceived dietary quality and choice of brand.

For someone whose perceived dietary quality is good, food choices will be of high involvement, and for someone whose perceived dietary quality is poor, food choices will be of low participation while buying food items. For this research, we need to categorize the consumers to understand how advertising can influence them.

The route of persuasion taken up by an advertisement can be determined by the brand endorser so that if a celebrity endorses the product, it takes the peripheral route. If an unpopular entity supports the development, it takes the main path. Therefore the way of persuasion taken up by the brands that claim to be healthy can be determined by its brand endorser.

When they desire a shortcut to make a choice, consumers turn to heuristics. “The Heuristic representativeness is a style of thinking that perceives one unique situation as comparable to another. The heuristic availability encourages individuals to depend on accessible knowledge, even if imperfect. People de- pending on heuristic anchoring and adaptation prefer to build their decision based on an anchor - they refer their decisions to a starting point for adjusting their assessment. A bad factor is described as the tendency to give negative items more weight. Family heuristic, the individuals tend to have more favorable sentiments towards more everyday items, significantly influencing cognitive activity. Labels are heuristic cues that may help consumers with their buying decision. And thus, for this research, we will identify the labels or claims of the brands that determine the buying decision of the consumers”.

The Halo effect makes consumers look at one product favorably if other related products have been good so far may encourage consumers to pick products from brands that they perceive to be healthy or organic, depending upon the heuristic cues that they receive will help us understand if the brand image will help form consumers’ perception of healthy food or not.

• •    Null Hypothesis (H₀) – Perceived Dietary Quality is independent of celebrity brand endorsers of milk as shown in Table 1 supplement.

• •    Alternate Hypothesis (H₁) – Perceived Dietary Quality is dependent on celebrity brand endorsers of milk supplements.

• •    Null Hypothesis (H₀) – Perceived Dietary Quality is independent of celebrity brand endorsers of cold beverages.

• •    Alternate Hypothesis(H₁) – Perceived Dietary Quality is dependent on celebrity brand endorsers of cold beverages.

• •    Null Hypothesis (H₀) – Perceived Dietary Quality is independent of celebrity brand endorsers of hot beverages.

• •    Alternate Hypothesis (H₁) – Perceived Dietary Quality is dependent on celebrity brand endorsers of hot beverages.

• •    Null Hypothesis (H₀) – Perceived Dietary Quality is independent of celebrity brand endorsers of dry snacks.

• •    Alternate Hypothesis(H₁) – Perceived Dietary Quality is dependent on celebrity brand endorsers of dry snacks.

• •    Null Hypothesis(H₀) – Perceived Dietary Quality is independent of celebrity brand endorsers of cereals.

• •    Alternate Hypothesis(H₁) – Perceived Dietary Quality is dependent on celebrity brand endorsers of cereals.

• •    Null Hypothesis (H₀) – Perceived Dietary Quality is independent of celebrity brand endorsers of semi-cooked meals.

• •    Alternate Hypothesis (H₁) – Perceived Dietary Quality is dependent on celebrity brand endorsers of semi-cooked meals.

• •    Null Hypothesis (H₀) – Perceived Dietary Quality is independent of celebrity brand endorsers of biscuits.

• •    Alternate Hypothesis(H₁) – Perceived Dietary Quality is dependent on celebrity brand endorsers of biscuits.

Results

• •    Null hypothesis (H₀) – Perceived dietary quality is independent of labels, as shown in Table 2.

• •    Alternate Hypothesis(H₁) – Perceived Dietary Quality is dependent on labels.

• •    Null hypothesis(H₀) – Choice of the brand is independent of the perception of the brand being healthy.

• •    The alternate hypothesis(H₁) – Choice of the brand depends on the brand’s perception of being healthy, shown in Table 3.

Findings

Table 1

ANOVA for hypothesis 3.3.1-3.3.7

Perceived dietary quality and celebrity endorsements (BG=Between Groups, WG=WithinGroups)

	Sum of Squares	df	Mean Square	F	Sig.
Milk Supplements
BG	1.932	1	1.932	2.464	.118
WG	155.223	198	.784
Total	157.155	199
Cold Beverages
BG	5.683	1	5.683	7.396	.007
WG	151.373	197	.768
Total	157.055	198
Hot Beverages
BG	.150	1	.150	.189	.664
WG	157.005	198	.793
Total	157.155	199
Dry Snacks
BG	3.619	1	3.619	4.667	.032
WG	153.536	198	.775
Total	157.155	199
Cereal
BG	1.646	1	1.646	2.096	.149
WG	155.509	198	.785
Total	157.155	199
Semi Cooked Meals
BG	.720	1	.720	.912	.341
WG	156.435	198	.790
Total	157.155	199
Biscuits
BG	.231	1	.231	.292	.590
WG	156.924	198	.793
Total	157.155	199

Table 1 shows the ANOVA for hypotheses 3.3.13.3.7

Interpretation

P-value of Milk Supplements=0.118 >0.05; therefore, we fail to reject the null hypothesis implies that the Perceived Dietary Quality is independent of celebrity brand endorsers of Milk Supplements.

The P-value of cold beverages =0.007<0.05; therefore, we reject the null hypothesis, implying that Perceived Dietary Quality depends on celebrity brand endorsers of Cold Beverages.

The P-value of hot beverages=0.664 > 0.05; therefore, we fail to reject the null hypothesis that suggests that perceived dietary quality is independent of celebrity brand endorsers of Hot Beverages.

P-value of dry snacks =0.032< 0.05; therefore, we reject the null hypothesis, implying that Perceived dietary quality depends on brand endorsers of dry snacks.

P-value of cereals=0.149 > 0.05. Therefore, we fail to reject the null hypothesis that Perceived dietary quality is independent of celebrity brand endorsers of Cereals.

P-value of semi-cooked meals=0.341 >0.05; therefore, we fail to reject the null hypothesis implies that Perceived dietary quality is independent of celebrity brand endorsers of Semi-Cooked Meals.

P-value of biscuits =0.590 >0.05. Therefore, we fail to reject the null hypothesis that Perceived Dietary Quality is independent of celebrity brand endorsers of Biscuits.

Table 2

Chi-Square test for hypothesis 3.3.8

(LR= Likelihood Ratio, L by L Assn.=Linear by Linear Association, N of Valid Cases)

	Value	df	Asymptotic Significance (2-sided)
Cold Beverages * [rich in vitamins and iron]
Pearson Chi-Square	15.616a	8	.048
LR	15.200	8	.055
L by L Assn.	.854	1	.355
VC	200
Hot Beverages * [antioxidant]
Pearson Chi-Square	42.448a	16	.000
LR	45.262	16	.000
L by L Assn.	3.593	1	.058
VC	200
Hot Beverages * [better metabolism]
Pearson Chi-Square	34.269a	16	.005
LR	39.135	16	.001
L by L Assn.	5.994	1	.014
VC	200
Hot Beverages * [enriched with nutrients
Pearson Chi-Square	29.331a	16	.022
LR	32.446	16	.009
L by L Assn.	10.149	1	.001
VC	200
Dry Snacks * [baked]
Pearson Chi-Square	64.689a	12	.000
LR	68.569	12	.000

	Value	df	Asymptotic Significance (2-sided)
L by L Assn.	12.334	1	.000
VC	200
Dry Snacks * [complete nutrition]
Pearson Chi-Square	35.035a	12	.000
LR	36.459	12	.000
L by L Assn.	4.074	1	.044
VC	200
Cereal * [weight control]
Pearson Chi-Square	34.261a	12	.001
LR	36.624	12	.000
L by L Assn.	.318	1	.573
VC	200
Cereal * [complete nutrition]
Pearson Chi-Square	33.406a	12	.001
LR	37.941	12	.000
L by L Assn.	.087	1	.768
VC	200
Cereal * [rich in iron]
Pearson Chi-Square	33.581a	12	.001
LR	35.952	12	.000
L by L Assn.	.157	1	.692
VC	200
Semi-Cooked Meals * [whole grain with natural vegetables]
Pearson Chi-Square	27.201a	16	.039
LR	29.529	16	.021
L by L Assn.	2.712	1	.100
VC	200
Semi-Cooked Meals * [complete nutrition]
Pearson Chi-Square	56.148a	16	.000
LR	68.478	16	.000
L by L Assn.	28.656	1	.000
VC	200
Semi-Cooked Meals * [rich in protein and fiber]
Pearson Chi-Square	50.702a	16	.000
LR	58.688	16	.000
L by L Assn.	26.912	1	.000
VC	200
Biscuits * [rich in fiber]
Pearson Chi-Square	41.325a	16	.000

	Value	df	Asymptotic Significance (2-sided)
LR	47.064	16	.000
L by L Assn.	11.627	1	.001
VC	200
Biscuits * [complete nutrition]
Pearson Chi-Square	27.994a	16	.032
LR	33.714	16	.006
L by L Assn.	9.496	1	.002
VC	200
Biscuits * [rich in vitamins]
Pearson Chi-Square	29.002a	16	.024
LR	30.323	16	.016
L by L Assn.	5.783	1	.016
VC	200

Interpretations

P-value of Cold Beverages * [rich in vitamins and iron] =0.048 < 0.05; therefore, the null hypothesis is rejected implies that Buyers perceive cold beverages to be rich in vitamins and iron.

P-value of Hot Beverages * [antioxidant] <<0.05, therefore, the null hypothesis is rejected implies that Buyers perceive hot beverages to be good antioxidants.

P-value of Hot Beverages * [better metabolism] << 0.05, therefore, the null hypothesis is rejected implies that buyers perceive hot beverages to help in better metabolism.

P-value of Hot Beverages * [enriched with nutri-ents]=0.022<0.05. Therefore, the null hypothesis is rejected implies that Buyers perceive hot beverages to be enriched with nutrients.

A P-value of Dry Snacks * [baked]<<0.05, therefore, the null hypothesis is rejected implies that Buyers perceive dry snacks to be baked.

A P-value of Dry Snacks * [complete nutrition]<< 0.05, therefore, the null hypothesis is rejected implies that Buyers perceive dry snacks to have complete nutrition.

A P-value of Dry Snacks * [filled with good-ness]=0.033 < 0.05, therefore, the null hypothesis is rejected implies that Buyers perceive dry snacks to be filled with goodness.

P-value of Cereal * [weight control]<< 0.05, therefore, the null hypothesis is rejected implies that Buyers perceive cereals to be suitable for weight control.

P-value of Cereal * [complete nutrition] << 0.05, therefore, the null hypothesis is rejected implies that Buyers perceive cereals to have complete nutrition.

P-value of Cereal * [rich in iron] << 0.05, therefore, the null hypothesis is rejected implies that Buyers perceive cereals to be rich in iron.

The A P-value of Semi-Cooked Meals * [whole grain with natural vegetables]= 0.039< 0.05. Therefore, the null hypothesis is rejected implies that Buyers perceive semi-cooked meals to have whole grains with real vegetables.

A P-value of Semi-Cooked Meals * [complete nu-trition]<<0.05, therefore, the null hypothesizes rejected implies that Buyers perceive semi-cooked meals to have complete nutrition.

A P-value of Semi-Cooked Meals * [rich in protein and fibre] << 0.05, therefore, the null hypothesis is rejected implies that Buyers perceive semi-cooked meals to be rich in protein and fibre.

P-value of Biscuits * [rich in fibre]<<0.05, therefore, the null hypothesis is rejected implies that Buyers perceive biscuits to be rich in fibre.

P-value of Biscuits * [complete nutrition]=0.032< 0.05, therefore, the null hypothesis is rejected implies that Buyers perceive biscuits to have complete nutrition.

P-value of Biscuits * [rich in vitamins]=0.024 <0.05, therefore, the null hypothesis is rejected implies that Buyers perceive biscuits to be rich in vitamins.

Issue 20. November 2021 | Cardiometry | 67

Nutrient Facts and Perceived Healthy Product

Table 3

Choice of brand and perception of the brand being healthy ANOVAafor Hypothesis 3.3.9

Model		Sum of Squares	df	Mean Square	F	Sig.
1	Regression	43.041	7	6.149	4.492	.000b
	Residual	262.834	192	1.369
	Total	305.875	199
a. Dependent Variable: nutrient facts
b. Predictors: (Constant), [healthyMilkSupplements], [healthyColdBeverages], [healthyHotBeverages],[healthyDrySnacks], [healthyCereals], [healthySemiCookedMeals], [healthyBiscuits]

Interpretation

P-value << 0.05; therefore, we reject the null hypothesis implying that brand choice depends on the brand’s perception is healthy.

Conclusion

As seen in columns, buyers are not influenced by celebrity endorsements when they buy milk products, hot beverages, cereals, semi-cooked meals, and biscuits. Therefore, the peripheral route of advertising will not affect them when they buy products that claim to be healthy in the categories mentioned above. Instead, they are influenced by the central route of advertising. But they are influenced by celebrity endorsements when they buy cold beverages and dry snacks, as seen in columns; therefore, the peripheral way of advertising will affect them when they buy products that claim to be healthy in the categories mentioned above.

Buyers get influenced by heuristic cues like rich in vitamin and iron when they buy cold beverages, antioxidant, better metabolism, enriched with nutrients when they buy hot beverages, baked, complete nutrition, filled with better when they purchase dry snacks, weight control, complete nutrition, rich in iron when they buy cereal, whole grain with natural vegetables, complete nutrition, rich in protein and fibre, when they purchase semi-cooked meals, rich in fibre, complete nutrition, rich in vitamins when they buy biscuits as shown in Table 2

People who claim to check nutrient facts perceive that the products that claim to be healthy are healthy implies that they might still get influenced by the health claims of the products as shown in Table 3

Further research needs to be done to understand why buyers find it difficult to choose healthy food items over junk food items.

Statement on ethical issues

Research involving people and/or animals is in full compliance with current national and international ethical standards.

Conflict of interest

None declared.

Author contributions

The authors read the ICMJE criteria for authorship and approved the final manuscript.