Poor Eating Habits: ‘Informing Is No Longer Enough'

Medscape

19-05-2025

The 9th edition of the 'Nourrir Liège' festival was held in mid-April, with this year's theme centred on the concept of One Health — the interconnection between human, animal, and environmental health. Among the many conferences, one session focused on the hidden costs of food, offering a platform for Axelle Hoge, PhD, associate professor and public health researcher at the University of Liège, Belgium, to examine why many Belgians struggle with poor dietary habits and to propose actionable solutions.
The following interview was conducted by MediQuality , a Medscape Network platform, after her presentation at the event.
In your view, why is it now more difficult to clearly link nutrition and health?
Today, it has become increasingly difficult for the general public, health professionals, and researchers to draw a direct connection between diet and health. This is largely due to the complexity of so-called societal diseases, which are typically multifactorial in nature. While diet clearly plays a recognized role in the development of conditions such as obesity, type 2 diabetes, cardiovascular disease, certain cancers, and osteoporosis, it is only one of many contributing factors. Genetic predisposition, physical activity, exposure to environmental pollutants, and stress also influence the onset of these diseases. This interplay of multiple causes makes the relationship between diet and health more difficult to understand and quantify — even though we know that nutrition remains a major tool for disease prevention.
Was the association between diet and health more obvious in the past?
Yes, the connection used to be more apparent. In cases of nutritional deficiency, specific clinical symptoms would develop that directly pointed to the problem. I'm thinking, for example, of kwashiorkor or scurvy. It was immediately clear that the diet was lacking in either quantity or quality. Today, the situation is much more complex.
Do you think Belgian consumers are poorly informed about nutrition?
I believe they are generally aware of the main dietary recommendations. However, putting them into practice is another matter. For instance, does the average person really know what concrete steps to take to reduce their intake of unhealthy fats? I'm not so sure.
We need to move away from the idea that everything depends on information alone. For a long time, public health campaigns operated on the assumption that people simply didn't know what was good or bad for their health. That perspective is outdated. Knowledge alone is not enough to change behaviour.
Conditions like obesity and other diet-related diseases cannot be fully explained by individual choices. Our eating habits are heavily influenced by the environment in which we live. On one hand, there's the social environment — family, friends, and coworkers influence our eating behaviour through imitation and social norms. On the other hand, the physical environment — supermarkets, restaurants, schools, and workplaces — determines what foods are available, in what quantities, and at what prices. Finally, the macro-environment plays a role: food production, processing, and distribution systems, agricultural policies, and marketing all shape our dietary choices.
Have these three influencing factors — the social, physical, and macro-level environments — evolved in recent years?
Yes, all three have changed significantly over the past few decades, and these changes clearly contribute to the current rise in multifactorial diseases. Foods high in sugar, unhealthy fats, and salt have become much more widespread. Portion sizes have increased, and ready-made meals are more accessible than ever. At the same time, we now spend less time on meals, and the availability of fast food and the intensity of food marketing have exploded. Altogether, these shifts have altered our eating habits — often not for the better.
What do we know about the measurable links between diet and mortality?
One of the most comprehensive sources is the 2017 Global Burden of Disease Study, which evaluated the health effects of diet in 195 countries. The study found that approximately one in five deaths worldwide is attributable to dietary risks. In terms of morbidity, it estimated that around 255 million years of healthy life are lost annually due to chronic diseases worsened by poor diets.
Three specific dietary factors were identified as particularly harmful: excessive salt intake, low consumption of whole grains (such as wholemeal bread and brown rice), and insufficient fruit consumption. However, it's worth noting that the study focused solely on nutritional quality — factors like chemical contamination and the level of food processing were not included, even though they clearly play a role in health outcomes.
We often hear that ultra-processed products are harmful. Why is that?
In Belgium, about 35% of the adult population's daily caloric intake comes from ultra-processed foods, according to the NOVA classification. These are foods that have undergone extensive industrial processing, including chemical, biological, or physical transformations. Such processes alter the food matrix, which is the structural and functional architecture of a food item.
Two foods may have the same nutritional composition on paper but differ in matrix, leading to different effects on health. For example, in dairy products, changes to the matrix caused by processing can affect satiety and nutrient absorption. Additionally, ultra-processed foods often contain ingredients not typically found in traditional cooking, such as additives, colourings, artificial flavours, emulsifiers, hydrogenated oils, and modified proteins. A growing body of research links these ingredients to obesity, type 2 diabetes, and other chronic health conditions.
Could including the NOVA score on product labels positively influence consumer purchasing behaviour?
While information alone doesn't solve everything, it would likely raise public awareness about the degree of food processing and its impact on health. Currently, I believe most people are poorly informed on this issue — especially since the level of processing is not among the five core public dietary recommendations.
If both the NOVA score and the Nutri-Score were made mandatory on food labels, products receiving unfavourable ratings from both systems could face reputational and commercial consequences. That level of transparency could also motivate manufacturers to reformulate their products to improve health profiles.
There is scientific literature exploring how the two labelling systems could be combined. Unfortunately, given the European Commission's decision not to mandate the Nutri-Score, we do not appear to be heading in the right direction.
What solutions do you see for helping consumers make better dietary choices?
We need to implement changes at multiple levels of the food environment. A number of evidence-based interventions are already recognized by local, national, and international authorities. These include restricting marketing of unhealthy foods, tightening regulation of additives, taxing sugar-sweetened beverages, implementing policies that make fresh, minimally processed foods more accessible.
Equally important is providing comprehensive nutritional education from an early age. While these interventions can directly influence eating behaviours, they are not sufficient on their own.
On a broader scale, we need to rethink how food is produced, processed, and distributed. This calls for systemic change and agricultural policies that prioritize quality over quantity.
What role can health professionals play in encouraging this change?
A strong alliance between researchers, health professionals, activists, citizens, and environmental groups can form a meaningful counterbalance to dominant forces in the food system. This coalition has the potential to produce and share independent knowledge, mobilize public opinion, and influence policy change.
However, for such a movement to be truly impactful, it must be supported by a systemic understanding of food issues. That means institutional backing, sustained public funding, and a political will that prioritizes public health and the common good. Sadly, when we look at current debates — such as those around university funding — the direction does not appear promising.
Do you think health professionals' voices carry more weight with public authorities than others?
Yes, I believe health professionals can play a more central role. Their voices carry a high degree of public trust and credibility, which can shape public debate and influence decision-making.
That said, to make a lasting impact, health professionals need to be well-informed about the broader dimensions of food systems, including not only nutrition and patient care but also social, economic, and environmental factors.
Creating the conditions and support systems that enable their active participation in public discourse and advocacy is also crucial. There is still significant progress to be made in this area.
Despite the challenges, are you optimistic about the future of our diets?
I try to remain optimistic — especially as someone at the beginning of my career. Through my research, I'm increasingly aiming to contribute to policy discussions and engage with communities on the ground.
There are promising local initiatives, particularly in Liège, that show how things can move forward. While these efforts currently tend to reach more affluent populations, we're starting to see some projects extend to disadvantaged groups as well. That's an encouraging sign, especially since much remains to be done to reduce social inequalities in nutrition and health.