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Social Science & Medicine 72 (2011) 1131e1139

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Social Science & Medicine

journal homepage: www.elsevier .com/locate/socscimed

Why healthy eating is bad for young people’s health: Identity, belonging and food

Martine Stead a,*, Laura McDermott a, Anne Marie MacKintosh a, Ashley Adamson b

a Institute for Social Marketing, University of Stirling and The Open University Stirling, Stirling FK9 4LA, UKbNewcastle University, UK

a r t i c l e i n f o

Article history:Available online 24 February 2011

Keywords:North east EnglandNutritionHealthy eatingAdolescentsSchool foodFood brandsIdentityBelongingUKQualitative research

* Corresponding author. Tel.: þ44 (0) 1786 467387E-mail address: martine.stead@stir.ac.uk (M. Stead

0277-9536/$ e see front matter � 2011 Elsevier Ltd.doi:10.1016/j.socscimed.2010.12.029

a b s t r a c t

Research into young people and healthy eating has focussed on identifying the ‘barriers’ to healthy eatingand on developing interventions to address them. However, it has tended to neglect the emotional, socialand symbolic aspects of food for young people, and the roles food might play in adolescence. This paperexplores these issues, reporting findings from a qualitative study which explored the meanings andvalues young people attached to food choices, particularly in school and peer contexts. As part of a largerstudy into young people’s relationships with food brands, 12 focus groups were conducted with youngpeople aged 13e15 in the North East of England. The focus groups found that young people used foodchoices to help construct a desired image, as a means of judging others, and to signal their conformitywith acceptable friendship and peer norms. Importantly, the findings suggested that the social andsymbolic meanings associated with healthy eating conflicted with processes and values which are ofcrucial importance in adolescence, such as self-image and fitting in with the peer group. In other words,it was emotionally and socially risky to be seen to be interested in healthy eating. Interventions need notonly to make healthy eating easier and more available, but also to address young people’s emotionalneeds for identity and belonging.

� 2011 Elsevier Ltd. All rights reserved.

Background

Introduction

Research into why young people do not eat as healthily as desiredhas identifiedanumberofbarriers suchas theirphysical environment,which contains multiple cues promoting the consumption of energydense foods (Kahn & Wansink, 2004; Painter, Wansink, & Hieggelki,2002; Tuomisto, Tuomisto, Hetherington, & Lappalainen, 1998;Yancey et al., 2009); the superseding nature of factors inherent infoods (i.e. taste, smell, appearance) to instigate consumption in youngpeople (Stevenson, Doherty, Barnett, Muldoon, & Trew, 2007);inconsistencies between large portion size, satiation and subsequentenergy intake compensation (Ello-Martin, Ledikwe, & Rolls, 2005;Rolls, 2003; Wansink & Chandon, 2006); and control seeking behav-iours during adolescencewhichmay lead to unhealthy diet choices asa reaction toparental controlling influence (Hill, 2002). Themajorityofstudies in a recent systematic review (Hanson & Chen, 2007) sug-gested that low socio-economic status adolescents have poorer dietsthan their higher socio-economic status peers, regardless of age,gender, measures of SES or ethnicity.

; fax: þ44 (0) 1786 466449.).

All rights reserved.

A recent systematic review of young people’s own perceptionsof the barriers identified a wide range of factors, including the easyavailability of unhealthy food, limited access to healthy alternatives,and a preference for the taste of ‘fast food’ (Shepherd et al., 2006).The same review notes that another barrier is young people’stendency to associate ‘unhealthy food’with desirable concepts suchas friendship, pleasure and relaxation (Shepherd et al., 2006);however, generally research tends to focus on the functional andrational barriers to healthy eating, and to neglect food’s moreemotional and symbolic dimensions. Food can be seen as a socio-cultural product with a meaning and importance far beyond itsnutritional or calorific content (Sylow & Holm, 2009). Fischler(1988) comments that “the way any given human group eatshelps it assert its diversity, hierarchy and organisation, and at thesame time, both its oneness and the otherness of whoever eatsdifferently” (p. 275). In many cultures and groups, the reasons forchoosing or rejecting particular foods are bound up with concernsover identity, image, social belonging and status (eg Fox & Ward,2008; Tivadar & Luthar, 2005).

For young people in particular, such concerns are of paramountimportance. Adolescence is a period of uncertainty and transition inwhich young peoplemove through role confusion to an achievementof personal identity (Hill, 2001). At the same time as striving for theirown identity, young people seek to belong and not stand out fromthe peer group (Wills, 2005). Peer group relations assume increasing

M. Stead et al. / Social Science & Medicine 72 (2011) 1131e11391132

importance in adolescence (Pombeni, Kirchler, & Palmonari, 1990)and can buffer young people from feelings of anxiety and alienationin a period of rapid change (Newman, Lohman, & Newman, 2007).Equally, deviation from peer group norms can lead to ridicule andbullying (eg Wooten, 2006). Consequently, adolescents strive to beaccepted by others and to avoid ostracisation by fitting in with peergroup expectations (eg Hendry & Reid, 2000). It is important not todeviate too far from acceptable norms or to appear too different fromthe peer group’s values, as there are critical social consequences foryoung people who make ‘wrong’ choices e too much individualityand difference can result in stigma or exclusion (Valentine, 2000).

Consumer behaviour literature suggests that onemeans of copingwith these challenges is through consumption: the acquisition andconsumption of material goods become, in adolescence, strategiesfor expressing identity and acquiring prestige among one’s peers(Belk, 1988). How these concerns about image and social statusmanifest themselves in consumption behaviours such as buyingbranded goods or adopting particular styles of fashion has beenexplored in various marketing and consumer studies (eg Chaplin &John, 2005; Hogg, Bruce, & Hill, 1998; Piacentini & Mailer, 2004). Ithas also been explored in literature on substance use, where studieshave examined, for example, the meanings and values associatedwith particular tobacco and alcohol brands among young people (egGordon, Moodie, Eadie & Hastings, 2010; Grant, Hassan, Hastings,MacKintosh, & Eadie, 2008; Hastings, Ryan, Teer, & MacKintosh,1994) and how behaviours around smoking, drinking and drug useare connected with concerns about image and peer group dynamics(eg Amos, Gray, & Currie, 1997; MacFadyen, Amos, Hastings, &Parkes, 2003). However, it has received less attention in the litera-ture on young people and food. This study set out to build on thisresearch, and to deepen understanding of how such concerns mightcome into play in young people’s food choices.

The importance of consumption in adolescence

Consumer behaviour research suggests that products havequalities which go beyond their functional attributes e they havethe ability to carry and communicate cultural meanings(Wattanasuwan, 2005). People use products as a means of culti-vating and projecting desired identities (eg Belk, 1988). Consumergoods can be used as a form of ‘symbolic self-completion’, wherebythe symbolic meanings associated with the product, and particu-larly the brand, transfer, through ownership and visible use, to theindividual wearing or using it (Elliott & Leonard, 2004; Elliott &Wattanasuwan, 1998). The act of purchasing and consumingdifferent products can be understood as part of a person’s self-presentation strategy e the desired self he or she presents or‘performs’ to others in social settings (Goffman, 1959). Just as thesymbolic meanings of goods can be used as an outward expressionof the sort of person one wishes to present to others, similarly,people draw inferences about others based on the products theyconsume and judge them accordingly (Belk, Bahn, & Mayer, 1982,1984).

For adolescents, the consumption of products serves twoimportant functions e it helps them to create and present a desiredidentity, and it helps them to ‘fit in’with a desired peer group. Youngpeople arehighlyconscious of howothers in their social groupmightinterpret the meanings of particular products and brands, and maychoose or reject items according to the perceived values and opin-ions of otherswhomatter to them (Piacentini &Mailer, 2004). Just ascertain products and brands are positively selected because they areperceived tobe congruentwitha consumer’s desired identity, othersare avoided because they evoke negative stereotypes which mayassociate the consumer with an undesired identity, group or trend(eg Hogg & Banister, 2001). Such processes rely on all parties having

a shared understanding of the meaning of particular consumptionbehaviours, products and brands (eg Elliot, 1994).

Sending out the right messages about one’s image and attainingpeer approval is particularly important where products are ‘visibly’or ‘conspicuously’ consumed e worn or used in social settings(Bachmann, John, & Rao, 1993). Consumer behaviour studies havetended to concentrate on visible and high involvement products,such as clothing andmobile phones (eg Hogg et al., 1998; Piacentini& Mailer, 2004; Wilska, 2003). Less attention has been paid inconsumer behaviour research to food and drink, perhaps becausethey tend to be regarded as lower visibility, lower involvementproducts (eg Kuenzel & Musters, 2007). However, some researchinto young people’s food preferences has suggested that the imageand prestige associated with particular food and drink productsmay be seen as important in terms of projecting the right identityto one’s peers. For example, in a qualitative interview study with7e14-year old English schoolchildren, Roper and La Niece (2009)found that they perceived the likes of Cadbury’s, Walkers and Kit-Kat as expensive and proper brands which would be ‘cool’ andacceptable to their peers. There is also research to suggest thatchoosing and eating food serve as shared consumer activitiesthrough which young people can express affinity to preferred peergroups. For example, Wills (2005) describes how a group of 16e24year old young people adopted particular food consumption habitsafter leaving school as a way of ‘fitting in with’ new social groupsand cultures. Similarly, Sylow and Holm (2009) observed teenagersin a sports centre cafeteria choosing similar foods to one anotherand sharing those foods, in order to express friendship and identity.Another example of this phenomenon is demonstrated by youngpeople fromminority ethnic backgrounds choosing to eat ‘western’foods when with their peers in order to ‘fit in’ (eg Ludvigsen &Sharma, 2004; Lv & Brown, 2010).

The study reported here sought to explore these themes further.As part of a larger study, funded by the UK Department of Health,into the role of branding in young people’s food choices in general,we conducted qualitative research to explore how young peopleuse and interpret food and drink products, focusing in particular onone social context e the school packed lunch e where concernsabout image and peer opinion might be particularly salient. Thestudy was approved by the University of Stirling Research EthicsCommittee and conducted under strict adherence to the Universitycode of ethics for research.

Methods

For this element of the wider study we conducted qualitativefocus groups with young people in English school years 9, 10 and 11(age 13e16). We chose this age group firstly because it falls withinJohn’s (1999) ‘reflective’ stage of consumer development, whenyoung people’s understanding of consumer brands becomes fairlyadvanced and they begin to express strong brand preferences (John,1999). Secondly, we wanted to explore how young people usebrands within the context of independent purchasing. By the timethey reach their early teenage years, young people are likely to buyfood for themselves both during the school day and while social-izing with friends at the weekend. Thirdly, young people of this ageare likely to have a relatively good understanding of the health-fulness of different foods. This allowed us to explore any tensionbetween brand influence and knowledge about what is acceptable/not acceptable to eat. The focus groups were conducted in Spring2007, and the wider study ran from 2007e2008.

As this was a previously little-researched area, the approachwaslargely inductive, although an initial conceptual framework for thework was provided by the research questions and also by keyconcepts and theories in the branding literature; for example, the

M. Stead et al. / Social Science & Medicine 72 (2011) 1131e1139 1133

notion that desirable attributes associated with brands mighttransfer to their owners (Chaplin & John, 2005), and that peoplemake inferences about others based on the products they consume(Belk et al., 1984). An initial focus group discussion guide wasdeveloped based on this conceptual framework, and was reviewedand adapted as the research progressed, to reflect emergingpriorities and themes. The order of introducing key themes wasvaried across the groups, such that some began with a generaldiscussion of food before moving to an exploration of branding,some began with a discussion of branding in different contextsbefore moving on to food, and others began with exploring youngpeople’s lifestyles and leisure activities before moving to the twothemes of food and brand consumption. This variation in the orderin which themes were introduced, done in order to approach theissue of food branding from different angles, did not appear toaffect the findings across the groups.

Wewere aware that it is difficult to ask people directly about theinfluences on their food choices, and also of the particular nebu-lousness of branding as a concept. Direct questioning would beunlikely to elicit the symbolic meanings and emotions associatedwith particular foods and food brands. This suggested to us a need toapproach the key themes indirectly and creatively rather thanthrough conventional questioning. Drawing on techniques used inprevious consumer behaviour research to explore young people’sinvolvement with products and brands (eg Hogg et al., 1998;Piacentini & Tinson, 2003; Tinson, 2009), we developed a varietyof questioning techniques, including card sort exercises to explorethe relative importance of different influences on food choices. A key

Lun chbox personification

This activity was designed to explore the symbolic and e

particular food product categories and brands. They we

lunchboxes from a range of food items which the mode

included both premium brands such as Coca Cola, W

supermarket economy brands such as Asda Smart Price,

(fruit, water, sugary drinks, crisps, confectionery). Respo

contained a sandwich, and then to choose from the rest o

the following kinds of people:

A Trendy Person

An Untrendy Person

A Popular Person

An Unpopular Person

A Geeky Person

A Healthy Person

An Unhealthy Person

Someone with a lot of money

Someone who doesn’t have a lot of money

A celebrity (such as David Beckham, Jade Goody ,

They were also asked to assemble a lunchbox which their

approve of, and which they themselves would like.

Fig. 1. ‘Lunchbox personification’ te

technique was ‘lunchbox personification’, inwhich we asked youngpeople to select typical food and drink products for a particular typeof person’s lunchbox, or to describe the sort of person who mighthave a particular selection of products in their lunchbox (see Fig. 1).Up to 45% of UK secondary schoolchildren bring a lunchbox or‘packed lunch’ to school at least some of the time (Gregory, Lowe,Bates, & et al, 2000), and this activity was therefore one withwhich respondents would have been able to identify.

The focus group discussions lasted around one and a quarterhours each and were conducted in informal venues such ascommunity centres and hotels. Each group was moderated by oneof the authors. The discussions were recorded using a digital audiorecorder, and transcribed in full for analysis.

Sample and recruitment

The sample was comprised of young people from threecommunities in theNorth East of England. TheNorth East of Englandwas chosen because it is considered representative of the UK asawhole in termsof levels of social affluenceanddisadvantage (Officeof the Deputy Prime Minister, 2003). The focus groups were strati-fied by three variablese school year group, gender and social classeto increase homogeneity in the groups and so that any differencesbetween groups could be more easily explored in the analysis (seeFig. 2). We were particularly interested in the possible influence ofsocial class on response because the consumer behaviour literaturesuggests that greater importancemay be attached to having sociallydesirable brands by young people from lower income groups

motional associations that young people make with

re invited to assemble ingredients for hypothetical

rator took in to the group discussions. The items

alkers, Cadbury’s, Muller and Volvic water, and

and included both healthier and less healthy items

ndents were asked to imagine that each lunchbox

f the products an appropriate lunchbox selection for

Kate Moss)

parents would approve of, which their friends would

chnique used in focus groups.

Fig. 2. Focus group sample breakdown.

M. Stead et al. / Social Science & Medicine 72 (2011) 1131e11391134

(Croghan, Griffin, Hunter, & Phoenix, 2006; Piacentini & Mailer,2004). There are also known gender and social class differences inattitudes and behaviour in relation to healthy eating (Farhat,Iannotti, & Simons-Morton, 2010; Van Lenthe et al., 2009). Socialclass was identified on the basis of social grade of the occupation ofhead of household, using standard market research society defini-tions (MRS, 2006), and young people were classified as either socialclass ABC1 (equivalent to middle class) or social class C2DE (equiv-alent toworking class). Each focus groupcomprised between six andeight respondents (total sample n ¼ 80).

Respondents were recruited door-to-door by self-employedmarket research consultants using a short recruitment question-naire to ensure that each individual met the appropriate samplecriteria. We deliberately avoided recruiting respondents fromschools which were participating in a questionnaire survey beingconducted as part of the wider study, to avoid sensitising eithergroup to the other element of the study, but did recruit, as far aspossible, from schools within the same neighbourhoods as thesurvey schools. Information on the characteristics of schoolsparticipating in the wider study is reported elsewhere (Stead,MacKintosh, McDermott, Anker, & Adamson, 2009).

Informed parental opt-in consent was sought for all respon-dents, and full information was provided outlining the study andwhat was required of the participant. Respondents were offereda CD or book token for taking part.

Analysis

The transcripts were coded and analysed using grounded theorytechniques in which the themes emerge from the participants’perspectives. Conceptual maps were drawn up of key relationships,such as the relationship between brands and experiences andperceptions of healthy eating. Two of the authors independentlyread and coded the transcripts, following which key themes andconcepts were agreed through discussion and further re-reading ofthe transcripts. Verbatim extracts from the group conversations areused in the paper to illustrate the findings. It was not possible in thetranscription process to differentiate each individual respondent,therefore we do not use the convention of labelling speakers“Respondent 1”, “Respondent 2” and so on when reproducingextracts of conversations.

Findings

We focus here on three key themes which emerged from thedata. Firstly, despite initially differentiating food from goods moreobviously associated with image and social status, young people didattach meanings to and judge others on the basis of their foodchoices. Secondly, thesemeanings and judgements encouraged andsupported the use of some brands and stigmatised others (and byextension, those who used them). Thirdly, on the basis of thesemeanings and judgements, the selection of ‘healthy’ choices wassocially risky. Each of these themes is now illustrated more fully.

i) Food choices carry meanings and judgements

In our focus groups, young people spoke animatedly about theimportance of having the right brand of consumer goods such asclothes and mobile phones. Having an inferior or unrecognisedbrand could damage image and standing in the peer group,exposing the wearer to a continuum of disparagement from“getting the mick/mickey taken” (being teased) through to bullyingand marginalisation (in the quotes below, ‘Rebel Active’ is a brandname used by the clothing retailer Primark, and ‘nardy’ and ‘raggy’are derogatory terms used in the North of England to signifysomething or someone who is ‘cheap’):

“Oh, yes, like D-, we take the mick out of him because he thought hehad a really good phone that played monophonic ring tones.”(Boy,Year 9, C2DE)

“Like, Rebel Active, it’s a nardy make.” “It’s just this make no oneever wears.” “Someone would come and put a bag over your head ifyou wore it.” “Because it’s raggy, cheap, nasty.”(Boys, Year 10,C2DE)

“If you don’t get jeans with a make [i.e. a brand] you get calleda tramp and stuff.”(Girl, Year 9, C2DE)

When asked whether the same considerations came into playwith regard to their food choices, the focus group participantsinitially tended to argue that, because food products did not formpart of one’s visual identity, the same concerns did not apply.

“You wear the jeans.” “Yes, because you wear the jeans!” “You wantto look good.” “No one takes notice of what food you eat.”(Girls,Year 11, ABC1)

At a rational level, young people derided the notion thatanyone’s image or social position could be either bolstered orharmed by the foods which they consumed. They asserted thatfriends had little influence on the food they chose, either positively(in the sense of wanting to buy the same things) or negatively (inthe sense of not wanting to buy something which would attractdisapproval). However, as the exchange below shows, peer influ-ence did appear to operate indirectly, in that young people werenonetheless sensitive to the possibility of being mocked by theirpeers on the basis of unusual or unacceptable food choices:

“They [friends] just wouldn’t care at all [about what you ate].”“Yes.” “They wouldn’t care at all.” “They’d care about it if you pulledout a Smart Price [low price ‘no frills’ range associated with theBritish supermarket chain Asda] or Aldi [discount supermarketchain] or something.” “Aldi beans.” Moderator: “They would careabout that?” “Yes, they’d laugh at you if you had that.” “They’dlaugh at the banana too.”(Boys, Year 11, C2DE)

Even food choices and consumption behaviours which did notseem particularly odd or extreme could arouse anxiety over what

M. Stead et al. / Social Science & Medicine 72 (2011) 1131e1139 1135

friends might think. In one group of girls, for example, the notionthat someone might bring a pot of yoghurt from home to schoolprovoked laughter. The significance of the exchange below is theway in which it reveals the existence of a strong and sharedconsensus among the group regarding what was acceptable.

“You wouldn’t have a yoghurt I don’t think because then you’d haveto have a spoon!” “Yes.” “That is not cool.” Moderator: “Spoons arenot cool?” “Not.” Moderator: “Really?” (All laughing)Moderator: “What do you mean?”“You look stupid getting a big metal spoon out of your bag.”“It’s just not good.”Moderator: “I have a yoghurt at work everyday, what musteveryone think!” (All laughing)“It’s an embarrassment to get a spoon out!”(Girls, Year 11, ABC1)

ii) Approved versus stigmatised brands

Young people in our groups did, then, attach values andmeanings to the food choices made by their peers. As with clothingand mobile phones, certain brands were approved and sociallyacceptable, while others were seen as detrimental to one’s imageand social position. This was illustrated in the ‘lunchbox game’,where young people of both genders, both social class groupingsand all years tended to associate mainstream brand products withthe positive concept of ‘popularity’. The implication was thatbuying and consuming such products was consistent with a posi-tive self-concept and a well-regarded social position. For example,one group of social class ABC1 boys, when asked to select whata ‘trendy person’ e someone who keeps up with the latest trendsemight put in their lunchbox, immediately picked out mainstreambrand products e Cadbury’s Dairy Milk chocolate, Walkers potatocrisps (known as Lay’s outside the UK), Dairylea cheese strings,Coca Cola. These products would be chosen by a trendy person,they argued, because the names were “big” and because sucha person would want to have “the best” products and for otherpeople to “know where [they’re] shopping” (Boys, Year 9, ABC1).Similar associations weremade by a group of social class C2DE girls,who also made a link between being popular and choosing high fatfoods and drinks:

Moderator: “What about a ‘popular person’?” “The Coca Cola andthe Pepsi.” “Yes. All the fat foods basically.” “Crisps.”(Girls, Year 9,C2DE)

Bringing mainstream premium brand food products into schoolwas not only good for one’s image, but was seen to act as a safe-guard against attracting unwanted attention and disapproval. Thisdesire to conformwas felt to be particularly acute for young peoplewhose social status was insecure. So, paradoxically, one group ofYear 9 social class ABC1 girls chose a very similar selection ofmainstream brand products e Cadbury’s chocolate, Twirl confec-tionery, a can of Pepsi and Dairylea cheese strings e for an‘unpopular person’s’ lunchbox. This was not because they associ-ated such brands with unpopularity, but because they felt that theunpopular person would both indulge in comfort eating to cheerthemselves up, and, importantly, would seek to “blend in” throughtheir consumption behaviour with the rest of their (more popular)peers.

The implication from both sets of comments above was thatmainstream brand products reflected and signalled a secure socialposition in the peer group. In contrast, inferior or generic brands,such as a retailer’s own brand, were associated with negativeconcepts such as unpopularity and being a ‘nerd’ e an ‘uncool’person not in the mainstream. As this group of social class C2DEboys explained:

Moderator: “What would an unpopular person have?” “Probablyhave all the nerdy stuff.” “Probably have that.” Moderator: “Whatdo you mean by nerdy stuff?”“Asda’s [British supermarket chain] chocolate and Asda’s yoghurtand Asda’s crisps.”(Boys, Year 9, C2DE)

Even more damaging to one’s image and social standing werebrands associated with poverty and low social status, such asdiscount supermarkets. While mainstream supermarket brandswere mocked as ‘nerdy’ and ‘not cool’, discount brands eliciteda harsher and more cruel response, as this exchange by a group ofsocial class ABC1 boys illustrates:

Moderator: “If I came into school with a Netto [European discountsupermarket chain] lunch, like crisps and a Netto drink, wouldanyone make a comment about it?”“Yes.”“Yes, probably.”“They sing a little song and.” Moderator: “Say that again?” “N-E-T-T-O, Netto is the place to go.” [parodying an advertising jingle]“N-E-T-T-O, Netto is the place to go.” “Shop all day, shop all night,fill your basket full of.” “Shop all day, shop all night, fill yourbasket with Netto.” “.S-H-I-T.” [all laughing](Boys, Year 9, ABC1)

Behind these sorts of comments appeared to lie a more funda-mental anxiety, not so much about the perceived cheapness andquality of the products sold by low budget supermarkets, but aboutthe threat to one’s own image of looking poor and cheap: in theirown words, “nardy”, “cheap” “raggy” or “like a tramp”.

“You don’t go to Netto.” “It’s a cheap and nasty shop.”“It’s raggy, you can get a can of beans for about three pence orsomething.”“And then when you open it the beans are supposed to be orangebut they’re green.” “My Nana goes there, my Nana’s raggy.”“It’s a brand for raggy old people, yes.”(Boys, Year 10, C2DE)

This anxiety seemed to be particularly keenly felt by youngpeople of lower social class, perhaps because it was of greaterimportance to them to distance themselves from a perceived pooridentity. This group of social class C2DE girls described the likelyreaction from their peers to bringing a lunch containing productsfrom the discount supermarket chain Aldi to school:

“They probably wouldn’t say anything to you but the look.” “Butthey’d give you dirty looks and talk about you to your friends.”“They’ll look at you, look and then whisper. Like oh my God, whatshe’s got!”Moderator: “What would they be saying to each other then behindmy back?”“They’d be sniggering and giggling and stuff.”“They’d be like, oh my God.”“She must be poor or something. Not exactly poor but not a lot ofmoney.”(Girls, Year 9, C2DE)

Interestingly, some young people claimed that they themselveswould be immune from any disapproval or ridicule if they had the‘wrong brands’ because theywere “solid” and populare their socialstanding could not be damaged. One group of girls suggested thatsomeone who “was just normal and not a geek or a charver[derogatory term in the North of England for a white working classyouth]” could be seenwith own brand or low budget food productswithout necessarily being teased or judged (Girls, Year 9, ABC1). Itseemed that only resilient young people, such as those who werepopular, and, conversely, young people who were already so mar-ginalised that nothing they did could improve their standing in thepeer group e could afford to make food choices which markedthem out as different.

M. Stead et al. / Social Science & Medicine 72 (2011) 1131e11391136

iii) The social risks of healthy eating

The third theme of interest in our findings was the idea that, formany young people, being seen to be interested in healthy eatingpotentially exposed them to social risk. To understand why healthyeating could be associatedwith jeopardising one’s image and statusin the peer group, we must first of all understand the meaningsassociated with and values placed on healthy eating for the youngpeople in our focus groups.

For one particular group of respondents e a group of social classC2DE boys who played sport e healthy eating had some positiveconnotations because it was seen as consistent with and ablepotentially to enhance their sporting ability:

Moderator: “What are the benefits from eating healthily?” “Keepfit.” “You can do more stuff.”(Boys, Year 9, C2DE)

For these boys, for whom sport was part of their self-image andstatus in the school, controlling their weight through physicalactivity and diet was an important way to carry on “looking good”and being fit enough to participate. For others in our groups,however, healthy eating did not seem to be valued as important anddid not form part of their image or identity. Many, particularly lowersocial class girls, described how they loved ‘junk’ food and ‘every-thing that’s bad for you’. Evenwhere concerns about body image andweight were expressed, particularly among girls, these tended tomanifest themselves in unhealthy eating patterns such as skippingmeals and snacking on junk food. Although most of the groupsshared a perception that being obese was undesirable, the undesir-ability often rested primarily in the perceived damage to one’s imageand status rather than any health consequences e ie. if you were fat,you were teased. In nearly all groups, discussion of obesity ledquickly to the identification of particular children in the school whowere ‘fat’, and generated humorous and disparaging comments.

Moderator: “So it’s important to you to eat healthily so you don’tget fat?”“Yes.”Moderator: “Any other reasons?”“People will take the mickey out of you.”“Yes.”Moderator: “Do they?”“Yes, if you’re fat in school they call you ‘fatty’ and stuff like that.”

(Girls, Year 9, C2DE)

Despite the perceived social risks of being obese, it was equallyrisky to strive too hard to be thin: “You don’t want to be fat, but youdon’t want to be geek skinny” (Girls, Year 9, ABC1). In a culturewherejunk foodwas the norm, striving to be ‘geek skinny’marked one outas odd and trying too hard. There was an implication that suchbehaviour was not normal, and a slightly defiant embracing of an‘unhealthy but proud’ identity.

“Nobody cares about their weight in Darlington.”(Girls, Year 11,C2DE)

These contradictory positions on healthy eating were particu-larly illuminated by the lunchbox game. When selecting productsfor different types of people, young people sometimes associatedhealthy eating with desirable characteristics such as ‘trendiness’and ‘popularity’, and sometimes with their opposites. The associ-ation between healthy eating and trendiness was explained by onegroup by a perceived social norm tending towards healthier eating:“It’s getting more healthy, because now, it’s the ‘in’ thing to be healthy.”(Boys, Year 11, ABC1). Others perceived quite the reverse: a socialtrend of rising obesity and fast food consumption, against whichhealthy eating was freakish and atypical.

“It’s not so normal to have a healthy lunch.”“I think Britain is getting more big, if you know what I mean e

fat.”(Girls, Year 9, C2DE)

Reflecting these different views, one group of social class boysfilled a ‘trendy person’s’ lunchbox with largely healthy items e

“apples, water, fruit” (Boys, Year 9, C2DE) e because they perceivedthat such a person would be interested in “looking good”, dressingwell and “fitting into skinny jeans”. Interestingly, however, two othergroups which selected bottled water, Yakult (a Japanese brand ofpro-biotic yoghurt drink) and fruit for the trendy person’s lunchboxalso included a pack of Walker’s crisps and a bottle of Coke,reflecting a perception that the trendy person would also wantpremium brand snack products.

In contrast, this group of social class ABC1 boys unanimouslyfilled a lunchbox for a ‘non-trendy person’with healthier products:

Moderator: “What would a non-trendy person have in theirlunchbox?” “Yakult.” [all laughing] “An apple.” “Highlandwater.”(Boys, Year 9, ABC1)

The clear implication here, as evidenced in the shared laughter,was that an overt interest in healthy eating was associated withbeing untrendy: with people who did not have a cool identity andwere in some way laughable. In the following exchanges, healthyeatingwas associatedwith “nerds” and “geeks”e young peoplewhodrew the wrong sort of attention to themselves or were distancedfrom the mainstream of acceptance by virtue of being too clever oresoteric in their interests.

[Selecting products for an ‘unpopular person’s’ lunchbox] “Nerdystuff” “Have all the healthy stuff, like there’s these kids up at the tablewith new plates for the vegetables.” “The StarWars fans”Moderator:“The what?” “Like the Star Wars fans.”(Boys, Year 9, C2DE)

[Selecting products for a ‘geeky person’s’ lunchbox] “Think of all thehealthy stuff.” “Everything healthy.” “Water, banana, yoghurt,cheese strings.” Moderator: “Why would a geeky person picka healthy lunch?” “Because they would want you to think they weresmart and that.” “They know everything, so they would know whatwas healthy for them.”(Girls, Year 9, ABC1)

The following extracts from one group discussion illustrateparticularly well how healthy eating was associated with exclusionfrom the popular mainstream. When asked to select a lunchbox foran ‘unhealthy person’ and an ‘unpopular person’, this group of socialclass C2DE girls automatically gave to the ‘unhealthy person’many ofthe high fat, salt and sugar products which they themselves liked:Coca Cola, Pepsi, Walker’s crisps, and Cadbury’s chocolate, alongsideAsda chocolate bars. When then asked to select a lunchbox for an‘unpopular person’, they selected almost the reverse of the productsthey had selected for an unhealthy person. Although these girlsstruggled to explain why they had associated unpopularity with thehealthy products, the implicationwas that healthy eating was a non-mainstream, slightly freakish activity associated with people witha poor image and low social status.

Moderator: “What does ‘unpopular’ mean?”“Not very popular.”“You’re not known well. In school.”“Because if you’re popular everyone knows you.”Moderator: “Has liking got something to do with it?”“Yes.” [all agree]“A lot of friends as well.”Moderator: “So an unpopular person is someone that doesn’t havea lot of friends and not well liked? What would you pick out forlunch for our unpopular person?”

M. Stead et al. / Social Science & Medicine 72 (2011) 1131e1139 1137

“I would say healthy foods. I don’t know why but I’d say healthyfoods, such as the water, the banana and the yoghurt.”“The yoghurt.”“The raisins.”“The raisins and the cheese strings.”Moderator: “Why would you say that?”“Most unpopular [people] normally eat healthier.”Moderator: “Do they?”“I don’t know.” [laughing].Moderator: “Why would they?”“I don’t know. They just tend to eat healthier.”Moderator: “It’s less normal to have a healthy lunch?”“Yes.”“Yes.”

(Girls, Year 9, C2DE)

Discussion

This qualitative study, part of a larger study into young people’sengagement with food brands, sought to uncover the social andsymbolic meanings associated with particular food products andbrands during a critical stage of young people’s social andpsychological development. For adolescents, consumption choicescan be used to support the image they choose to project and toexpress affinity with particular social or peer groups. Our studyexplored how concerns about image and belonging interact withand inform decisions about food consumption.

Our research was conducted within one area of the UK, theNorth East of England, and in this respect findings may not begeneralisable to young people in other parts of the UK or othercountries. Previous work investigating the diets of young people inthe North East has shown that although some regional differencesexist, food intake is broadly similar to that found in national surveys(Fletcher et al., 2004). Furthermore, other studies conducted withgeographically and culturally diverse groups of young people,support our findings with regard to the value attached by youngpeople to having popular mainstream food brands (eg Roper & LaNiece, 2009) and the importance of making food choices whichhelp one ‘fit in’with the peer group (eg Chapman & Maclean, 1993;Wills, 2005).With regard to our choice of focus groups, it is possiblethat a different qualitative method, such as individual interviews,would have yielded different responses, in that young people mayhave displayed less allegiance to group norms in their responses(for example, in the absence of others joining in, they may havebeen less disparaging of particular brands or of ‘fat’ people).However, because we were interested in how group norms shapeperceptions of food brands and healthy eating, we deliberatelychose this method. Hyde, Howlett, Brady, and Drennan (2005)suggest that focus groups can be “highly revealing in attemptingto understand the normative rules embedded in the culture fromwhich participants are drawn” (p. 2588). Instances of focus groupparticipants presenting a particular image to others or ridiculingthose who step out of line can illustrate vividly the veryphenomena they are intended to explore. Ridicule was a recurringfeature in the groups, being both evoked repeatedly as the fate ofyoung people whomake unacceptable food choices and also shownin action, such as when mocking those who shop at the discountchain Netto. Wooten (2006) notes how ridicule is a powerful forcein adolescents’ consumption behaviour, in that “the practice ofridicule both reflects and affects adolescents’ perceptions ofbelongingness, the content of ridicule conveys information aboutthe consumption norms and values of peer groups, and the expe-rience of ridicule influences the acquisition, use, and disposition ofpossessions” (p. 195).

In the groups we asked young people to imagine hypotheticallunchboxes for different types of people because we felt that thisindirect, projective form of questioning would be more likely touncover the meanings and values associated with different typesand brands of food than more direct questioning. Inevitably thelunchbox technique focused attention on the school context, wherepeer opinion is likely to be particularly salient. It is possible that infood choice contexts where eating is less public, such as the home,having brands or products that communicate a desirable imagemaybe less important than values such as familiarity and comfort (egDammler, Barlovic, & Clausnitzer, 2005). A potentialweakness in ourlunchbox method was that the labels we used to describe theirhypothetical ownerse ‘trendy’, ‘popular’, ‘geeky’ and so one are notnecessarily fixed constructs with shared meanings across all thegroups of young people. A more appropriate approach may havebeen to elicit eachgroup’sownterms for the constructswewished toexplore, rather than selecting them in advance.

Previous youth consumer research has tended to focus onproducts and behaviours where the potential to enhance or jeop-ardise one’s image and status within the group is more immedi-ately apparent, such as clothing and music choices (eg Hogg et al.,1998; Piacentini & Mailer, 2004; Wilska, 2003). In contrast, foodis a more ephemeral, lower involvement product category, whereone might expect concerns about image and social influence to beless salient (Kuenzel & Musters, 2007); as our focus grouprespondents put it, ‘you wear the jeans, you don’t wear the food’.Nevertheless, our study suggests that similar concerns andprocesses do come into play with food. Although it is a less obviousmarker of identity and social status than one’s brand of jeans orchoice of music, our research suggests that food is used by youngpeople to inform and support their identity and the ways theyrelate to and judge others.

The importance of projecting the right sort of image wasreflected in our study in preferences for mainstream products andbrands. Young people’s responses suggested that they were awareat some level that when they were seen consuming products andbrands such as Walker’s crisps, Pepsi, Coca Cola and Cadbury’schocolate, the desirable attributes associated with these brandstransferred to themselvese coolness, popularity, trendiness, and soon. These associations were not necessarily expressed directly, butcould be inferred indirectly from how young people assembledhypothetical lunchboxes for a ‘cool person’, a ‘popular person’ andso on. Similar associations between mainstream popular foodbrands and desirable attributes such as quality and popularity havebeen found in other research. For example, Duff (1999) suggeststhat when choosing soft drinks, teenagers rely on big brands that‘cannot be faulted’ by the peer group, and select them as much fortheir image as for their content. Similarly, Roper and La Niece(2009) found that adolescents preferred ‘proper’ brands oversupermarket brands in their school lunchbox because they were‘cool’, ‘popular’ and ‘other people would like them’. The same studynoted that young people were guided by “trend-setters” amongtheir peers as to which products they should be seen consuming. Itis notable that the most popular food and drink brands tend to befor products high in fat, salt and sugar. For example, when theresearch was conducted in 2007-8, the top food and non-alcoholicdrink brands in the UK Superbrands index (an annual league tableof brand strength) were Coca Cola (2nd place) and Cadbury (10thplace), the others in the top 50 being Kellogg’s, Heinz, Pepsi andMcDonald’s.

Just as itwas socially risky tobe seenwithownbrands andbudgetbrands because of their low status associations, so it was risky to beseen to be interested in healthy eating. Choosing to eat healthilywasfor many young people associated with a ‘geeky’, ‘nerdy’, untrendyimage which could attract teasing and marginalisation.

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The idea that healthy eating marks one out as different or is ‘notfor people like us’ has been supported in other research. Chapmanand Maclean’s (1993) qualitative research with Canadian teenagegirls found that while they regarded eating junk food as ordinaryteenage behaviour, healthy eating was associated with being withone’s parents, being at home and ‘weirdness’ e not the norm. Aqualitative study comparing 7-, 11- and 14-year old UK school-children’s lunchbox food brand preferences found that, for the14-year olds, ‘fitting in’ and ‘not standing out’ in the choices onemade were of paramount importance: “Peer pressure was so strongamong the 14-year olds and the unwritten rules about acceptable andunacceptable products so rigid that children are getting bullied in thissecondary school for consuming the wrong things. [One respondent]confirmed it was better to buy certain products which were consideredacceptable and cool rather than risk standing out and being bullied”(Roper & La Niece, 2009, pp. 91e92). A study into the barriers tohealthy eating among adults in a disadvantaged community (southWales) found that cost and lack of information were not the mainissues (O’Neill, Rebane, & Lester, 2004). Rather, the explanationseemed in part to be cultural: healthy eating was not seen assomething done by ‘people round here’ but by ‘other people’. Thiswas reflected in the attributes associated with ‘healthy people’,which included that they were ‘sad’, ‘miserable’, ‘moody’, ‘gymfreaks’ and ‘veggies’. Although healthy people were also perceivedto live longer, look better and have more energy, the implicationwas that, in the views of study participants, they attained these atthe cost of being less normal, having less fun and being less popular(O’Neill et al., 2004). This is powerfully echoed in our study,particularly among the lower social class girls who claimed not toknow anyone who strove to be thin and healthy: “Nobody caresabout their weight in Darlington.” The south Wales study suggeststhat unless this cultural ‘non-ownership’ of healthy eating isaddressed, dietary improvement will not be achieved in disad-vantaged communities “even if the resource and informationalbarriers are addressed” (O’Neill et al., 2004, p. 227).

Similarly, in a study of primary and secondary schoolchildren’sattitudes towards food in school (Ludvigsen & Sharma, 2004),participants of all ages found it “hard to imagine” the sort of youngperson who would deliberately choose a healthy lunch. They felt ithad to be someone much richer, cleverer (a goodyegoody), posherand sportier than themselves e an idealised personwho only existsin adverts and films where everyone is rich, active and healthy. Incontrast, they had no problem imagining and describing the sort ofyoung person who would choose a junk food lunch, because thissort of young person was widely known to them. The Ludvigsenand Sharma (2004) study also found that bringing “non-stan-dard” food items into school, such as economy brands or ethnicminority foods, risked ridicule among the young people, and notedthat practically all the packed lunches of the white children in thestudy were identical. Although young people in Ludvigsen andSharma’s (2004) study denied that they were influenced by theirfriends in relation to their food choices, they could give examples ofother children in the school being laughed at or bullied because ofwhat they ate: “[some] stressed that children will not get bulliedsimply because of what they eat, but said that if they are alreadytargets of bullying, unusual food might make them more vulnerable toridicule” (Ludvigsen & Sharma, 2004, p. 35).

These insights deepen our understanding of the ‘barriers’ tohealthy eating for young people. It is not simply that healthy eatingfails to appeal tomany young people, or is difficult for them; it is thatengaging in healthy eating symbolises something undesirable tothem and exposes them to uncomfortable social risk. This insightreflects awider truth about health behaviours. People’s decisions toengage in health-damaging behaviours rather than healthy behav-iours seem ‘irrational’ topublic health experts.However, choosing to

behave inwayswhichwill bolster rather than harmone’s image andplace in the peer group could be seen as a profoundly rationalresponse, if the risks of having an impaired self-image or standingout from the group are acute. In a study of the importance of peergroup acceptance and the strategies young people use to achieve it,Warrington and Younger (2010) note that “negotiating a positionwithin the mainstream, acceptable youth culture takes sensitivity andconsiderable skill” (p. 9). Newman et al. (2007) suggest that peopleare healthier and happier when they experience a feeling ofbelonging, and find that such a sense is positively associated withstrongermental health in adolescents. In this sense, we could arguethat it is actually good for young people’s ‘health’ e in the sense oftheir social and emotional well-beinge tomake food choices whichmake them feel good about themselves and help themmake strongsocial bondswith others. The problem for public health is that theseare often unhealthy choices. The challenge, then, is to developintervention solutions which recognise the enormous complexitiesof young people’s everyday lives e which meet their emotional aswell as their nutritional needs.

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