PHB-10314; No of Pages 5 Physiology & Behavior xxx (2014) xxx–xxx
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Weekly patterns, diet quality and energy balance Sinéad McCarthy ⁎ Consumer Behaviour for Food and Health, Food Market & Consumer Research Group, Department of Agrifood Business & Spatial Analysis, Rural Economy and Development Programme, Teagasc Food Research Centre, Ashtown, Dublin 15, Ireland
H I G H L I G H T S • • • •
Changes in daily patterns on the weekend contribute to changes in dietary patterns. Weekend dietary quality is poorer with higher fat, alcohol and energy intakes. There is an increase in sedentary behaviours on the weekend. Public health interventions should focus weekend diet and activity behaviours.
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Article history: Received 9 December 2013 Received in revised form 17 February 2014 Accepted 18 February 2014 Available online xxxx Keywords: Weekend Energy balance Inactivity Health promotion
a b s t r a c t Human behaviour is made up of many repeated patterns and habitual behaviours. Our day to day lives are punctuated by work, education, domestic chores, sleep and food. Changes in daily patterns such as not working in paid employment or attending school on the weekend contribute significantly to changes in dietary patterns of food consumption, patterns of physical activity and ultimately energy balance. The aim of this paper is to adopt a lifecourse perspective and explore the changes in dietary quality and physical activity patterns across the week from young children to elderly adults with a focus on Western cultures. Research literature indicates that the dietary quality is somewhat poorer on the weekends, characterised by higher fat intakes, higher alcohol intakes and consequently higher energy intakes. This increase in energy intake is not necessarily offset by an increase in activity, rather an increase in sedentary behaviours. Some research has observed an increase of more than 100 cal per day over the weekend in American adults. Over the course of one year, this can result in a significant increase in body mass. Some of the interventions in tackling obesity and diet related behaviours must focus on the changes in the weekend behaviour of consumers in terms of both food and activity. These efforts should also focus on increasing consumer awareness of the long term consequences of the short lived weekend excess as well as putting in place practical measures and interventions that are evidence based and targeted to consumer needs. © 2014 Elsevier Inc. All rights reserved.
1. Introduction “Biological rhythms are crucial phenomena that are perfect examples of the adaptation of organisms to their environment” [1]. It is this adaptation to a dynamic environment that has resulted in many variations in the daily and weekly rhythms of eating as humans adapt to the impact of work on their weekly environment. Eating routines are rooted in daily lives punctuated by work schedules, family commitments and recreational activities, but are also malleable and subject to change as personal and environmental circumstances vary [2]. Human behaviour is made up of many repeated patterns and habitual behaviours. Food choice is an extremely complex element of human behaviour that is very strongly influenced by habit [3] and very sensitive to change in external stimuli such as the social and physical ⁎ Tel.: +353 1 8059962 (direct line); fax: +353 1 8059550. E-mail address: [email protected].
environments [4]. This social environment we live in is frequently dictated and influenced by work, education, domestic chores, sleep and food. Changes in our daily time environment such as not having work or school commitments on the weekend contribute significantly to changes in dietary patterns of food consumption due to an increase in the time available to engage with food as well as the structure of the day and the availability of food over the day. 1.1. Weekly time patterns Weekly time use surveys are frequently conducted in many of the Organisation for Economic Co-Operation and Development (OECD) countries and provide a useful insight into human behaviour and the time environment in which we operate. A recent OECD [5] report on time use summarised in Table 1 shows that more than 50% of the 24 h day is accounted for by work and sleep combined, with work accounting for 19% and 35% is accounted for by sleeping. Eating and drinking,
http://dx.doi.org/10.1016/j.physbeh.2014.02.046 0031-9384/© 2014 Elsevier Inc. All rights reserved.
Please cite this article as: McCarthy S, Weekly patterns, diet quality and energy balance, Physiol Behav (2014), http://dx.doi.org/10.1016/ j.physbeh.2014.02.046
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Table 1 Participation in daily activities as a percentage of 24 h for OECD, Ireland and USA.
Paid work or study Unpaid work Routine housework Shopping Personal care Sleeping Eating & drinking Leisure Sports TV or radio Other
OECD 29 [5]
Ireland [6]
Weekly average
Weekday
Weekend
Weekday
Weekend
19 14 9 2 46 35 6 21 2 8 1
16 20 7 2 42 34 5 19 1 11 4
5 20 6 2 47 35 5 25 2 10 3
22 9 10 5 43 40 6 24 2 13 2
8 10 13 6 47 44 8 30 3 15 5
essential activities for life only amount to 6% of the day, while leisure accounts for 21%. Data were also available for Ireland [6] and the US [7] to conduct weekday to weekend comparisons. Remarkable weekday and weekend day differences are seen in particular for work, whereby time engaging in work activities decreased by 14% on the weekend. This decrease in work is somewhat accounted for by an increase in sleep and/or personal care and an increase in leisure activities. A small increase in the proportion of time eating and drinking was observed for the USA on the weekend compared to the weekday, while no change was observed in Ireland. Therefore weekly changes in the behaviour environment such as removing the daily structure of work and having increased access to foods on the weekend can influence food consumption patterns. 2. Weekly food patterns It is long established that healthy food consumption patterns and optimal nutrient intakes play a critical role in the prevention of many chronic non-communicable diseases. Hence, food and nutrition are the subject of much research to elicit improvements in food choice that may ultimately improve public health. However, for interventions to be effective they must be evidence based, culturally specific and take consumer behaviours and preferences into account. The aim of this
USA [7]
paper is to adopt a life-course perspective and explore the changes in dietary quality and physical activity patterns across the week from young children to elderly adults with a focus on Western cultures. Therefore, the aim of this review is to identify if the changing structure of the time environment on the weekend, influences food consumption practises and to identify how public health nutrition interventions can be designed to take account of potential weekly differences. Much of the research to date provides strong evidence that food intakes have a definite weekly pattern and subject to variation over the days of the week across all age groups of many different populations in Western society as summarised in Table 2. 2.1. Children An extensive study was undertaken in the USA ranging from young to the elderly, which very clearly demonstrated that changes occurred during weekend days compared to weekdays [8]. Overall in children a slight increase of 20 to 30 cal per day was observed with fat accounting for most of the increase [8]. Similarly, fat patterns and habits were also shown to change over the weekend in a study of fat practises in American children [9]. This study examined fat practises among children over the week. The percentage contribution of fat to energy from snacks increased on the weekend. Engaging in low fat practises
Table 2 Summary of weekday–weekend day effects on dietary intakes. Group
Country
Type of difference
Reference
Children
USA
[8]
Children
USA
Children Children
Sweden Denmark
Adolescents Adolescents
USA Denmark
Adults Adults Adults
USA USA USA
Adults
Spain
Adults
Ireland
Elderly
USA
Elderly
USA
Small non-significant differences in EI Lower protein intakes in 2–11 yr Higher fat intakes in 2–5 yr %EI higher from veg, poultry and eggs on Sunday %EI from fruit and milk higher on weekdays Frequency of consumption of nutrient dense foods higher on weekdays EI higher on weekends Higher sugar sweetened beverages and white bread Higher intake of confectionery and lower intake of fruits and veg Non-significant small increase in EI of 18 kcal Higher energy density from food and beverages on weekends Higher intakes of sugar sweetened beverages, cakes and biscuits Lower intakes of fruit and veg in girls Increase of 200 kcal on weekends when socialising Higher EI, fat and alcohol on weekends Higher EI, cho, fat, prot and alcohol on weekends Meal sizes larger on weekends Meals at later time on weekends Meal structure differences with higher consumption of fruit and yoghourt with weekday meals Alcohol more frequently consumed with meals on the weekend Higher proportion of eating at restaurants on weekends Higher proportion of energy from fat on weekends Little weekday and weekend differences in cereal and dairy consumption No difference in meal size or meal timing Higher fat intake on weekends Non-significant lower energy intake of 13 kcal per day on weekend
[28] [11] [12]
[8] [12]
[29] [8] [18]
[20] [21] [30] [18] [8]
EI = energy intake, yr = years, veg = vegetables, cho = carbohydrate, and prot = protein.
Please cite this article as: McCarthy S, Weekly patterns, diet quality and energy balance, Physiol Behav (2014), http://dx.doi.org/10.1016/ j.physbeh.2014.02.046
S. McCarthy / Physiology & Behavior xxx (2014) xxx–xxx
decreased on the weekend for each type of meal, while high fat practises at breakfast increased dramatically on Saturday and Sunday compared to the other weekdays [9]. Unfortunately this paper did not elaborate on the specific foods being consumed in terms of being able to determine the types of fat consumed and determine if it was monounsaturated fats from nuts and seeds which are beneficial or less desirable foods high in saturated fat. Fruit and vegetable differences have also been shown to be subjected to a weekday and weekend day effect in African-American and Hispanic 11 year old boy scouts. Consumption of fruit and vegetable decreased on the weekend, with the school lunch being the source of most fruit and vegetable consumption during the week. Juice consumption also decreased on the weekend, whereby it was consumed with 30% of breakfasts on the weekend compared to 50% of breakfasts during the week [10]. Similar patterns are also observed in many European countries. One study examined the frequency of the consumption of low and high nutrient foods across the week in both the childcare setting and the home setting in Swedish children [11]. They showed that the consumption of low/poor nutrient foods was more frequent on the weekend compared to weekdays and was also more prevalent in the home environment compare to the childcare setting. Not only was the frequency of intake of these low nutrient foods consistently low in the pre-school environment, but there was also a higher frequency of consumption of high nutrient foods such as fruit and vegetables compared to the home environment [11]. In Danish children, significant differences were observed in energy intake across the days of the week, with significantly higher intakes on the weekend characterised by higher intakes of sugar sweetened beverages, confectionery and lower consumption of fruit and vegetables [12]. Dietary pattern analysis was applied to these data in a subsequent study, which revealed two distinct patterns in these children named ‘healthy pattern’ and ‘processed pattern’ Weekly analysis of the patterns showed that the children consistently consumed less healthy foods on the weekend regardless of whether they followed a healthy dietary pattern or a processed food pattern during the week [13]. These dietary patterns have also been identified in British children whereby the traditional and health conscious patterns were associated with a better nutrient profile, although a weekday–weekend day comparison was not presented [14]. These weekly patterns are also evident in adolescents. American teenagers have a slightly higher energy intake of nearly 20 cal per day on weekends which is a result of higher fat consumption [8]. Meal patterns also show a weekly variation with a higher frequency of evening meal consumption on the weekend while breakfast and lunch are more frequently consumed during the weekday [15]. Weekend changes were also evident in Danish adolescents with a significantly higher consumption of energy dense foods and beverages characterised by higher intakes of cakes, biscuits and sugar sweetened beverages [12]. In addition, a significantly lower intake of fruit and vegetables was observed for girls. Higher intakes of fish as well as white bread were found in boys [12]. Contemporaries play a pivotal role in this group whereby friends with healthy patterns will display similarities to each other in the group. Therefore, nutritional health promotion may be more effective in adolescents if peer groups and networks are targeted to bring about a cohort effect of establishing healthy eating as the social norm for the group [16,17]. The biggest weekday effect has been reported in adults. American adults were found to consume significantly higher amounts of energy per day on the weekend, in some cases exceeding 100 kcal each day with fat and alcohol being the main contributors to this increase [8]. Another study on all ages of American adults showed increased intakes of energy, fat, carbohydrate, protein and alcohol over the weekend compared to weekdays, with the most notable differences in younger adults [18]. In addition, meal patterns were also subject to a variation with significantly larger meal sizes on the weekend as well a longer duration of meal times [18,19]. Consistent increases in energy intake over the weekend without compensation in either reduced weekday energy or
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increase in physical activity can have a significant cumulative effect on body weight status over the period of one year. An increase of 100 cal every weekend of one year will lead to an approximately two kilogramme increase in body mass thereby contributing to the ongoing increase in prevalence of overweight and obesity in Western cultures [8]. Similarly, changes in food consumption and meal patterns were also demonstrated in Spanish adults [20]. Fruit was consumed more frequently on weekdays compared to weekends. Water was the preferred beverage with meals during the week while this seemed to be replaced with wine on the weekends. There was a shift to later meal times on the weekend compared to during the week especially for breakfast and dinner. In particular, the percentage of breakfasts consumed decreased while the percentage of consumers of lunch and dinner increased [20]. Weekly patterns have also been demonstrated in Irish adults. The frequency of eating outside the home such as in restaurants and bars doubled in Irish adults on the weekend compared to weekdays [21]. The highest proportion of consumers eating out was observed on Saturdays. Fat intakes were also shown to vary over the week with intakes highest on weekends for meals consumed at home compared to meals at home on weekdays. However, when eating outside of the home fat intake was consistently high irrespective of weekday, with intakes consistently greater than 40% of energy from fat for all meals eaten out. Chips (also known as French fries) and processed potato products were the largest contributor to fat intakes in meals consumed outside the home [21]. Beverage consumption is also subject to weekly variation. In the UK total water and beverage consumption increased significantly on Fridays and Saturdays by approximately 250 g per day compared to the other days of the week. This increase was more marked in men and was primarily due to increase in alcohol. Unlike Spanish adults, water consumption did not decrease on the weekends and showed little weekday variation. A slight decrease was observed for hot beverages such as tea and coffee [22]. The impact of the weekend trigger appears to be very strong in adults even in the presence of dietary related illnesses. A study of French adults compared dietary patterns of those on a strict dietary regime for type 1 diabetes to adults with no illness. There was a significant increase in meal size observed in both groups on the weekend despite recommendations for the diabetic group to reduce meal size [23]. Hence, the impact of the weekend can have a stronger effect on dietary patterns than can the presence of an illness. Some of this increased consumption on the weekend may also be partly explained by social facilitation whereby food consumption can increase by as much as 60% when other people are present at a meal [24], as well as increase in the duration of the meal and meal size [25]. This social facilitation also varies depending on the type of company when dining, whereby women in the company of men will choose lower calorie foods compared to eating in the company of other women [26]. In general, changes in elderly meal and food consumption are less marked and influenced by the weekday/weekend pattern when compared to younger adults. de Castro studied all adult ages and showed that although there was an increase on the weekends for the elderly (aged 65 + years, healthy, free living) this was mainly due to an increase only in fat intake and not any of the other macronutrients [18]. This was in contrast to younger adults with a weekend increase in all of the macronutrients. Unlike the younger adults, there was little difference in the number of people present when consuming a meal or the time of meal consumption in the older groups [18]. Hence, older adults were less influenced by social facilitation and its association with larger and longer meals. However, as the more elderly groups are studied a different and more worrying trend can be observed. In general, the older adults eat very slightly (non-significant) less energy per day of 15 cal on the weekend with a reduction in carbohydrate accounting for this decrease [8]. In addition, other studies have shown a significant decrease in certain nutrients on the weekend compared to the weekdays. This is especially the case in people who are the recipient of home
Please cite this article as: McCarthy S, Weekly patterns, diet quality and energy balance, Physiol Behav (2014), http://dx.doi.org/10.1016/ j.physbeh.2014.02.046
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delivered meals, whereby the meals are only delivered on weekdays and the elderly people and not preparing a home cooked meal on the weekend [27]. 3. Physical activity If energy balance in terms of weekly patterns is to be discussed then physical activity which forms the other half of this balance equation also needs to be addressed. Are weekly patterns of physical activity and physical inactivity subjected to a weekly rhythm, and if so, do the changes in physical activity compensate for the increases observed in weekend energy intake or does a change in activity patterns contribute further a positive energy balance. Weekday and weekend day differences are less conclusive than in terms of physical activity with some studies showing an increase in activity and other studies showing a decrease in activity on weekends. In terms of physical activity, many studies have shown a weekend decrease in activity in children and adolescents in the UK, France and Spain over the weekend period [31–33]. This weekend decrease may be partly explained by or attributable to school day activities and more organised activities and sports taking place as part of the weekday routine. Physical activity has been shown to vary over the week in adults also with a dramatic decrease in physical activity counts observed on Sundays for both men and women [34]. However, what does seem to be apparent and consistent across populations is the increase in physical inactivity on weekends compared to weekdays. In terms of time spent in activities, as presented in Table 1, time spent in leisure activities increases on the weekend but not necessarily in sport. However, many studies do show an increase in inactivity mainly characterised by an increase in TV viewing. This increase in TV viewing on weekends is also associated with poorer dietary quality in children on weekends during increased TV viewing time [35]. A mechanism was proposed by Santaliestra-Pasías in 2013 to demonstrate how the increase in TV viewing can lead to an increase in energy intake and the prevalence in obesity [36]. It illustrates how low energy expenditure during TV viewing coupled with passive consumption of unhealthy high energy foods ultimately leads to an energy imbalance and ultimately obesity [36]. Similar to eating with others and the effects of social facilitation increasing consumption of foods, screen time, mainly in the form of TV viewing also seems to increase consumption albeit through a slightly different mechanism such as distraction. One study showed that eating while watching TV resulted in an increased energy intake by 14% [37], while another demonstrated an increased meal frequency associated TV viewing in American female students [38]. This increase in consumption is possibly a consequence of impaired self-monitoring as a result of the distraction with increased TV viewing. It also appears to be associated with less healthy food choices. TV viewing and screen time were inversely associated with fruit intake and positively associated with sweetened beverage consumption [36]. Moreover, TV viewing has also been shown to be independently associated with the metabolic syndrome [39]. Regardless of weekday, TV viewing has been reported as the most preferred leisure activity across all of the OECD countries surveyed [5]. Consequently, TV viewing is an important target for health and dietary promotion, given that there is both an increase in overall food consumption not compensated for in activity as well as increased consumption of less healthy foods while watching TV. 4. Implications Weekly eating patterns have been studied for many decades. Findings from the USDA's food consumption survey from 1977 to 1978 clearly demonstrated significant differences for meals, snacks, energy distribution as well as food type and nutrients consumed between weekdays and weekend days [40]. The findings are still comparable to more recent data from whereby more alcohol is consumed on weekend
days and that differences were less obvious than older adults [8]. Despite this knowledge available for many decades, very little has been done to focus public health nutritional campaigns on weekend consumer behaviour changes or targeting the weekday to compensate and offset weekend excesses. There is no doubt that the consistent transition to a less healthy pattern of behaviour on the weekend is in some way contributing to the high prevalence of obesity. One study has shown that excess on the weekend is not fully compensated for during the subsequent week [41]. These patterns have many consequences especially if a balance is not reached between the weekdays and weekends. Racette et al. examined the impact of weekend lifestyle on body weight and found that study participants gained weight over the weekend days but not on weekdays [42]. This increase was attributed to a higher dietary intake on Saturdays and the lowest weekly levels of physical activity on Sundays. This study also supports findings from the National Weight Control Registry in the USA where subjects successful at maintaining weight loss for greater than one year had more than one hour of physical activity per day, consumed a low calorie and low fat diet, had regular breakfasts, and most importantly had consistency in dietary and activity behaviours across weekdays and weekend days [43]. Hence, effective and holistic public health campaigns should focus on a decrease in physical inactivity such as TV viewing on the weekend because of its contribution to passive over consumption of food as well as consumption of energy dense low nutrient quality foods. 5. Food choice motives & consumer behaviour In many Western countries, taste is frequently cited as the most important motive for food choice and all food consumed is primarily driven by taste [44]. It is extremely rare that consumers are willing to compromise on taste regardless of the purported additional benefits a food may claim to offer [45]. Moreover, health is frequently ranked as the third or fourth motive driving food choice and is not a key consideration for many when making food choice [44]. Therefore, if taste is ranked as the most important factor in food choice and health lags behind in third or fourth place, public health campaigns should identify and use innovative ways to promote the taste, convenience and enjoyment of a healthy diet as opposed to solely focussing on the health aspect. Campaigns that are grounded in evidence and consumer focussed in this manner to suit the needs of the target audience have a greater likelihood of yielding the desired outcomes in terms of food choice and behaviour and public health. 6. Conclusions Despite the many methodological issues in the measurement of food consumption, such as survey design, misreporting, and defining weekends/meals, the evidence remains conclusive that a change in the weekday versus the weekend pattern exists in many Western societies and across all life stages from young to the elderly. These patterns should be considered in the development evidence based, consumer focussed, targeted public health campaigns. References [1] Botbol M, Cabon P, Kermarre S, Tordjman S. Biological and psychological rhythms: an integrative approach to rhythm disturbances in autistic disorder. J Physiol Paris 2013;107:298–309. [2] Jastran M, Bisogni C, Sobal J, Blake C, Devine CM. Eating routines. Embedded, value based, modifiable, and reflective. Appetite 2009;52:127–36. [3] Verplanken B, Wood W. Interventions to break and create consumer habits. J Public Policy Mark 2006;25:90–103. [4] Eertmans A, Baeyens F, Van den Bergh O. Food likes and their relative importance in human eating behaviour: review and preliminary suggestions for health promotion. Health Educ Res 2001;16:443–56. [5] Society at a glance 2011 — OECD social indicators. http://www.oecd.org/els/soc/ OECD_1564_Web.xls.
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Please cite this article as: McCarthy S, Weekly patterns, diet quality and energy balance, Physiol Behav (2014), http://dx.doi.org/10.1016/ j.physbeh.2014.02.046
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Weekly patterns, diet quality and energy balance Sinéad McCarthy ⁎ Consumer Behaviour for Food and Health, Food Market & Consumer Research Group, Department of Agrifood Business & Spatial Analysis, Rural Economy and Development Programme, Teagasc Food Research Centre, Ashtown, Dublin 15, Ireland
H I G H L I G H T S • • • •
Changes in daily patterns on the weekend contribute to changes in dietary patterns. Weekend dietary quality is poorer with higher fat, alcohol and energy intakes. There is an increase in sedentary behaviours on the weekend. Public health interventions should focus weekend diet and activity behaviours.
a r t i c l e
i n f o
Article history: Received 9 December 2013 Received in revised form 17 February 2014 Accepted 18 February 2014 Available online xxxx Keywords: Weekend Energy balance Inactivity Health promotion
a b s t r a c t Human behaviour is made up of many repeated patterns and habitual behaviours. Our day to day lives are punctuated by work, education, domestic chores, sleep and food. Changes in daily patterns such as not working in paid employment or attending school on the weekend contribute significantly to changes in dietary patterns of food consumption, patterns of physical activity and ultimately energy balance. The aim of this paper is to adopt a lifecourse perspective and explore the changes in dietary quality and physical activity patterns across the week from young children to elderly adults with a focus on Western cultures. Research literature indicates that the dietary quality is somewhat poorer on the weekends, characterised by higher fat intakes, higher alcohol intakes and consequently higher energy intakes. This increase in energy intake is not necessarily offset by an increase in activity, rather an increase in sedentary behaviours. Some research has observed an increase of more than 100 cal per day over the weekend in American adults. Over the course of one year, this can result in a significant increase in body mass. Some of the interventions in tackling obesity and diet related behaviours must focus on the changes in the weekend behaviour of consumers in terms of both food and activity. These efforts should also focus on increasing consumer awareness of the long term consequences of the short lived weekend excess as well as putting in place practical measures and interventions that are evidence based and targeted to consumer needs. © 2014 Elsevier Inc. All rights reserved.
1. Introduction “Biological rhythms are crucial phenomena that are perfect examples of the adaptation of organisms to their environment” [1]. It is this adaptation to a dynamic environment that has resulted in many variations in the daily and weekly rhythms of eating as humans adapt to the impact of work on their weekly environment. Eating routines are rooted in daily lives punctuated by work schedules, family commitments and recreational activities, but are also malleable and subject to change as personal and environmental circumstances vary [2]. Human behaviour is made up of many repeated patterns and habitual behaviours. Food choice is an extremely complex element of human behaviour that is very strongly influenced by habit [3] and very sensitive to change in external stimuli such as the social and physical ⁎ Tel.: +353 1 8059962 (direct line); fax: +353 1 8059550. E-mail address: [email protected].
environments [4]. This social environment we live in is frequently dictated and influenced by work, education, domestic chores, sleep and food. Changes in our daily time environment such as not having work or school commitments on the weekend contribute significantly to changes in dietary patterns of food consumption due to an increase in the time available to engage with food as well as the structure of the day and the availability of food over the day. 1.1. Weekly time patterns Weekly time use surveys are frequently conducted in many of the Organisation for Economic Co-Operation and Development (OECD) countries and provide a useful insight into human behaviour and the time environment in which we operate. A recent OECD [5] report on time use summarised in Table 1 shows that more than 50% of the 24 h day is accounted for by work and sleep combined, with work accounting for 19% and 35% is accounted for by sleeping. Eating and drinking,
http://dx.doi.org/10.1016/j.physbeh.2014.02.046 0031-9384/© 2014 Elsevier Inc. All rights reserved.
Please cite this article as: McCarthy S, Weekly patterns, diet quality and energy balance, Physiol Behav (2014), http://dx.doi.org/10.1016/ j.physbeh.2014.02.046
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Table 1 Participation in daily activities as a percentage of 24 h for OECD, Ireland and USA.
Paid work or study Unpaid work Routine housework Shopping Personal care Sleeping Eating & drinking Leisure Sports TV or radio Other
OECD 29 [5]
Ireland [6]
Weekly average
Weekday
Weekend
Weekday
Weekend
19 14 9 2 46 35 6 21 2 8 1
16 20 7 2 42 34 5 19 1 11 4
5 20 6 2 47 35 5 25 2 10 3
22 9 10 5 43 40 6 24 2 13 2
8 10 13 6 47 44 8 30 3 15 5
essential activities for life only amount to 6% of the day, while leisure accounts for 21%. Data were also available for Ireland [6] and the US [7] to conduct weekday to weekend comparisons. Remarkable weekday and weekend day differences are seen in particular for work, whereby time engaging in work activities decreased by 14% on the weekend. This decrease in work is somewhat accounted for by an increase in sleep and/or personal care and an increase in leisure activities. A small increase in the proportion of time eating and drinking was observed for the USA on the weekend compared to the weekday, while no change was observed in Ireland. Therefore weekly changes in the behaviour environment such as removing the daily structure of work and having increased access to foods on the weekend can influence food consumption patterns. 2. Weekly food patterns It is long established that healthy food consumption patterns and optimal nutrient intakes play a critical role in the prevention of many chronic non-communicable diseases. Hence, food and nutrition are the subject of much research to elicit improvements in food choice that may ultimately improve public health. However, for interventions to be effective they must be evidence based, culturally specific and take consumer behaviours and preferences into account. The aim of this
USA [7]
paper is to adopt a life-course perspective and explore the changes in dietary quality and physical activity patterns across the week from young children to elderly adults with a focus on Western cultures. Therefore, the aim of this review is to identify if the changing structure of the time environment on the weekend, influences food consumption practises and to identify how public health nutrition interventions can be designed to take account of potential weekly differences. Much of the research to date provides strong evidence that food intakes have a definite weekly pattern and subject to variation over the days of the week across all age groups of many different populations in Western society as summarised in Table 2. 2.1. Children An extensive study was undertaken in the USA ranging from young to the elderly, which very clearly demonstrated that changes occurred during weekend days compared to weekdays [8]. Overall in children a slight increase of 20 to 30 cal per day was observed with fat accounting for most of the increase [8]. Similarly, fat patterns and habits were also shown to change over the weekend in a study of fat practises in American children [9]. This study examined fat practises among children over the week. The percentage contribution of fat to energy from snacks increased on the weekend. Engaging in low fat practises
Table 2 Summary of weekday–weekend day effects on dietary intakes. Group
Country
Type of difference
Reference
Children
USA
[8]
Children
USA
Children Children
Sweden Denmark
Adolescents Adolescents
USA Denmark
Adults Adults Adults
USA USA USA
Adults
Spain
Adults
Ireland
Elderly
USA
Elderly
USA
Small non-significant differences in EI Lower protein intakes in 2–11 yr Higher fat intakes in 2–5 yr %EI higher from veg, poultry and eggs on Sunday %EI from fruit and milk higher on weekdays Frequency of consumption of nutrient dense foods higher on weekdays EI higher on weekends Higher sugar sweetened beverages and white bread Higher intake of confectionery and lower intake of fruits and veg Non-significant small increase in EI of 18 kcal Higher energy density from food and beverages on weekends Higher intakes of sugar sweetened beverages, cakes and biscuits Lower intakes of fruit and veg in girls Increase of 200 kcal on weekends when socialising Higher EI, fat and alcohol on weekends Higher EI, cho, fat, prot and alcohol on weekends Meal sizes larger on weekends Meals at later time on weekends Meal structure differences with higher consumption of fruit and yoghourt with weekday meals Alcohol more frequently consumed with meals on the weekend Higher proportion of eating at restaurants on weekends Higher proportion of energy from fat on weekends Little weekday and weekend differences in cereal and dairy consumption No difference in meal size or meal timing Higher fat intake on weekends Non-significant lower energy intake of 13 kcal per day on weekend
[28] [11] [12]
[8] [12]
[29] [8] [18]
[20] [21] [30] [18] [8]
EI = energy intake, yr = years, veg = vegetables, cho = carbohydrate, and prot = protein.
Please cite this article as: McCarthy S, Weekly patterns, diet quality and energy balance, Physiol Behav (2014), http://dx.doi.org/10.1016/ j.physbeh.2014.02.046
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decreased on the weekend for each type of meal, while high fat practises at breakfast increased dramatically on Saturday and Sunday compared to the other weekdays [9]. Unfortunately this paper did not elaborate on the specific foods being consumed in terms of being able to determine the types of fat consumed and determine if it was monounsaturated fats from nuts and seeds which are beneficial or less desirable foods high in saturated fat. Fruit and vegetable differences have also been shown to be subjected to a weekday and weekend day effect in African-American and Hispanic 11 year old boy scouts. Consumption of fruit and vegetable decreased on the weekend, with the school lunch being the source of most fruit and vegetable consumption during the week. Juice consumption also decreased on the weekend, whereby it was consumed with 30% of breakfasts on the weekend compared to 50% of breakfasts during the week [10]. Similar patterns are also observed in many European countries. One study examined the frequency of the consumption of low and high nutrient foods across the week in both the childcare setting and the home setting in Swedish children [11]. They showed that the consumption of low/poor nutrient foods was more frequent on the weekend compared to weekdays and was also more prevalent in the home environment compare to the childcare setting. Not only was the frequency of intake of these low nutrient foods consistently low in the pre-school environment, but there was also a higher frequency of consumption of high nutrient foods such as fruit and vegetables compared to the home environment [11]. In Danish children, significant differences were observed in energy intake across the days of the week, with significantly higher intakes on the weekend characterised by higher intakes of sugar sweetened beverages, confectionery and lower consumption of fruit and vegetables [12]. Dietary pattern analysis was applied to these data in a subsequent study, which revealed two distinct patterns in these children named ‘healthy pattern’ and ‘processed pattern’ Weekly analysis of the patterns showed that the children consistently consumed less healthy foods on the weekend regardless of whether they followed a healthy dietary pattern or a processed food pattern during the week [13]. These dietary patterns have also been identified in British children whereby the traditional and health conscious patterns were associated with a better nutrient profile, although a weekday–weekend day comparison was not presented [14]. These weekly patterns are also evident in adolescents. American teenagers have a slightly higher energy intake of nearly 20 cal per day on weekends which is a result of higher fat consumption [8]. Meal patterns also show a weekly variation with a higher frequency of evening meal consumption on the weekend while breakfast and lunch are more frequently consumed during the weekday [15]. Weekend changes were also evident in Danish adolescents with a significantly higher consumption of energy dense foods and beverages characterised by higher intakes of cakes, biscuits and sugar sweetened beverages [12]. In addition, a significantly lower intake of fruit and vegetables was observed for girls. Higher intakes of fish as well as white bread were found in boys [12]. Contemporaries play a pivotal role in this group whereby friends with healthy patterns will display similarities to each other in the group. Therefore, nutritional health promotion may be more effective in adolescents if peer groups and networks are targeted to bring about a cohort effect of establishing healthy eating as the social norm for the group [16,17]. The biggest weekday effect has been reported in adults. American adults were found to consume significantly higher amounts of energy per day on the weekend, in some cases exceeding 100 kcal each day with fat and alcohol being the main contributors to this increase [8]. Another study on all ages of American adults showed increased intakes of energy, fat, carbohydrate, protein and alcohol over the weekend compared to weekdays, with the most notable differences in younger adults [18]. In addition, meal patterns were also subject to a variation with significantly larger meal sizes on the weekend as well a longer duration of meal times [18,19]. Consistent increases in energy intake over the weekend without compensation in either reduced weekday energy or
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increase in physical activity can have a significant cumulative effect on body weight status over the period of one year. An increase of 100 cal every weekend of one year will lead to an approximately two kilogramme increase in body mass thereby contributing to the ongoing increase in prevalence of overweight and obesity in Western cultures [8]. Similarly, changes in food consumption and meal patterns were also demonstrated in Spanish adults [20]. Fruit was consumed more frequently on weekdays compared to weekends. Water was the preferred beverage with meals during the week while this seemed to be replaced with wine on the weekends. There was a shift to later meal times on the weekend compared to during the week especially for breakfast and dinner. In particular, the percentage of breakfasts consumed decreased while the percentage of consumers of lunch and dinner increased [20]. Weekly patterns have also been demonstrated in Irish adults. The frequency of eating outside the home such as in restaurants and bars doubled in Irish adults on the weekend compared to weekdays [21]. The highest proportion of consumers eating out was observed on Saturdays. Fat intakes were also shown to vary over the week with intakes highest on weekends for meals consumed at home compared to meals at home on weekdays. However, when eating outside of the home fat intake was consistently high irrespective of weekday, with intakes consistently greater than 40% of energy from fat for all meals eaten out. Chips (also known as French fries) and processed potato products were the largest contributor to fat intakes in meals consumed outside the home [21]. Beverage consumption is also subject to weekly variation. In the UK total water and beverage consumption increased significantly on Fridays and Saturdays by approximately 250 g per day compared to the other days of the week. This increase was more marked in men and was primarily due to increase in alcohol. Unlike Spanish adults, water consumption did not decrease on the weekends and showed little weekday variation. A slight decrease was observed for hot beverages such as tea and coffee [22]. The impact of the weekend trigger appears to be very strong in adults even in the presence of dietary related illnesses. A study of French adults compared dietary patterns of those on a strict dietary regime for type 1 diabetes to adults with no illness. There was a significant increase in meal size observed in both groups on the weekend despite recommendations for the diabetic group to reduce meal size [23]. Hence, the impact of the weekend can have a stronger effect on dietary patterns than can the presence of an illness. Some of this increased consumption on the weekend may also be partly explained by social facilitation whereby food consumption can increase by as much as 60% when other people are present at a meal [24], as well as increase in the duration of the meal and meal size [25]. This social facilitation also varies depending on the type of company when dining, whereby women in the company of men will choose lower calorie foods compared to eating in the company of other women [26]. In general, changes in elderly meal and food consumption are less marked and influenced by the weekday/weekend pattern when compared to younger adults. de Castro studied all adult ages and showed that although there was an increase on the weekends for the elderly (aged 65 + years, healthy, free living) this was mainly due to an increase only in fat intake and not any of the other macronutrients [18]. This was in contrast to younger adults with a weekend increase in all of the macronutrients. Unlike the younger adults, there was little difference in the number of people present when consuming a meal or the time of meal consumption in the older groups [18]. Hence, older adults were less influenced by social facilitation and its association with larger and longer meals. However, as the more elderly groups are studied a different and more worrying trend can be observed. In general, the older adults eat very slightly (non-significant) less energy per day of 15 cal on the weekend with a reduction in carbohydrate accounting for this decrease [8]. In addition, other studies have shown a significant decrease in certain nutrients on the weekend compared to the weekdays. This is especially the case in people who are the recipient of home
Please cite this article as: McCarthy S, Weekly patterns, diet quality and energy balance, Physiol Behav (2014), http://dx.doi.org/10.1016/ j.physbeh.2014.02.046
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delivered meals, whereby the meals are only delivered on weekdays and the elderly people and not preparing a home cooked meal on the weekend [27]. 3. Physical activity If energy balance in terms of weekly patterns is to be discussed then physical activity which forms the other half of this balance equation also needs to be addressed. Are weekly patterns of physical activity and physical inactivity subjected to a weekly rhythm, and if so, do the changes in physical activity compensate for the increases observed in weekend energy intake or does a change in activity patterns contribute further a positive energy balance. Weekday and weekend day differences are less conclusive than in terms of physical activity with some studies showing an increase in activity and other studies showing a decrease in activity on weekends. In terms of physical activity, many studies have shown a weekend decrease in activity in children and adolescents in the UK, France and Spain over the weekend period [31–33]. This weekend decrease may be partly explained by or attributable to school day activities and more organised activities and sports taking place as part of the weekday routine. Physical activity has been shown to vary over the week in adults also with a dramatic decrease in physical activity counts observed on Sundays for both men and women [34]. However, what does seem to be apparent and consistent across populations is the increase in physical inactivity on weekends compared to weekdays. In terms of time spent in activities, as presented in Table 1, time spent in leisure activities increases on the weekend but not necessarily in sport. However, many studies do show an increase in inactivity mainly characterised by an increase in TV viewing. This increase in TV viewing on weekends is also associated with poorer dietary quality in children on weekends during increased TV viewing time [35]. A mechanism was proposed by Santaliestra-Pasías in 2013 to demonstrate how the increase in TV viewing can lead to an increase in energy intake and the prevalence in obesity [36]. It illustrates how low energy expenditure during TV viewing coupled with passive consumption of unhealthy high energy foods ultimately leads to an energy imbalance and ultimately obesity [36]. Similar to eating with others and the effects of social facilitation increasing consumption of foods, screen time, mainly in the form of TV viewing also seems to increase consumption albeit through a slightly different mechanism such as distraction. One study showed that eating while watching TV resulted in an increased energy intake by 14% [37], while another demonstrated an increased meal frequency associated TV viewing in American female students [38]. This increase in consumption is possibly a consequence of impaired self-monitoring as a result of the distraction with increased TV viewing. It also appears to be associated with less healthy food choices. TV viewing and screen time were inversely associated with fruit intake and positively associated with sweetened beverage consumption [36]. Moreover, TV viewing has also been shown to be independently associated with the metabolic syndrome [39]. Regardless of weekday, TV viewing has been reported as the most preferred leisure activity across all of the OECD countries surveyed [5]. Consequently, TV viewing is an important target for health and dietary promotion, given that there is both an increase in overall food consumption not compensated for in activity as well as increased consumption of less healthy foods while watching TV. 4. Implications Weekly eating patterns have been studied for many decades. Findings from the USDA's food consumption survey from 1977 to 1978 clearly demonstrated significant differences for meals, snacks, energy distribution as well as food type and nutrients consumed between weekdays and weekend days [40]. The findings are still comparable to more recent data from whereby more alcohol is consumed on weekend
days and that differences were less obvious than older adults [8]. Despite this knowledge available for many decades, very little has been done to focus public health nutritional campaigns on weekend consumer behaviour changes or targeting the weekday to compensate and offset weekend excesses. There is no doubt that the consistent transition to a less healthy pattern of behaviour on the weekend is in some way contributing to the high prevalence of obesity. One study has shown that excess on the weekend is not fully compensated for during the subsequent week [41]. These patterns have many consequences especially if a balance is not reached between the weekdays and weekends. Racette et al. examined the impact of weekend lifestyle on body weight and found that study participants gained weight over the weekend days but not on weekdays [42]. This increase was attributed to a higher dietary intake on Saturdays and the lowest weekly levels of physical activity on Sundays. This study also supports findings from the National Weight Control Registry in the USA where subjects successful at maintaining weight loss for greater than one year had more than one hour of physical activity per day, consumed a low calorie and low fat diet, had regular breakfasts, and most importantly had consistency in dietary and activity behaviours across weekdays and weekend days [43]. Hence, effective and holistic public health campaigns should focus on a decrease in physical inactivity such as TV viewing on the weekend because of its contribution to passive over consumption of food as well as consumption of energy dense low nutrient quality foods. 5. Food choice motives & consumer behaviour In many Western countries, taste is frequently cited as the most important motive for food choice and all food consumed is primarily driven by taste [44]. It is extremely rare that consumers are willing to compromise on taste regardless of the purported additional benefits a food may claim to offer [45]. Moreover, health is frequently ranked as the third or fourth motive driving food choice and is not a key consideration for many when making food choice [44]. Therefore, if taste is ranked as the most important factor in food choice and health lags behind in third or fourth place, public health campaigns should identify and use innovative ways to promote the taste, convenience and enjoyment of a healthy diet as opposed to solely focussing on the health aspect. Campaigns that are grounded in evidence and consumer focussed in this manner to suit the needs of the target audience have a greater likelihood of yielding the desired outcomes in terms of food choice and behaviour and public health. 6. Conclusions Despite the many methodological issues in the measurement of food consumption, such as survey design, misreporting, and defining weekends/meals, the evidence remains conclusive that a change in the weekday versus the weekend pattern exists in many Western societies and across all life stages from young to the elderly. These patterns should be considered in the development evidence based, consumer focussed, targeted public health campaigns. References [1] Botbol M, Cabon P, Kermarre S, Tordjman S. Biological and psychological rhythms: an integrative approach to rhythm disturbances in autistic disorder. J Physiol Paris 2013;107:298–309. [2] Jastran M, Bisogni C, Sobal J, Blake C, Devine CM. Eating routines. Embedded, value based, modifiable, and reflective. Appetite 2009;52:127–36. [3] Verplanken B, Wood W. Interventions to break and create consumer habits. J Public Policy Mark 2006;25:90–103. [4] Eertmans A, Baeyens F, Van den Bergh O. Food likes and their relative importance in human eating behaviour: review and preliminary suggestions for health promotion. Health Educ Res 2001;16:443–56. [5] Society at a glance 2011 — OECD social indicators. http://www.oecd.org/els/soc/ OECD_1564_Web.xls.
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