obesity reviews doi: 10.1111/obr.

12472

Nutrition/Etiology

The barriers and enablers of healthy eating among

young adults: a missing piece of the obesity puzzle: A
scoping review

A. E. Munt, S. R. Partridge and M. Allman-Farinelli

School of Life and Environmental Sciences, Summary

Charles Perkins Centre, The University of
Sydney, Sydney, NSW, Australia
Received 10 July 2016; revised 18 August
2016; accepted 2 September 2016
Address for correspondence: Professor M.
Allman-Farinelli, Building D17, Charles Perkins
Centre, University of Sydney, Sydney, NSW
2006, Australia
E-mail: margaret.allman-farinelli@sydney.edu.
au
Young adults in Western countries are gaining weight faster than their parents
and are more likely to gain weight than any other age cohort. Despite this, in-
vestigation into the complex young adults’ food choice motives, which enable
and prevent healthy eating, has not been widely investigated. A scoping review
was conducted involving an extensive literature search of four major electronic
databases: Medline, Embase, PsychInfo and CINAHL. Data were collected from
34 articles: study descriptions numerically analysed and key findings themati-
cally analysed. The key barriers found included: male apathy towards diet; un-
healthy diet of friends and family; expected consumption of unhealthy foods
in certain situations; relative low cost of unhealthy foods; lack of time to plan,
shop, prepare and cook healthy foods; lack of facilities to prepare, cook and
store healthy foods; widespread presence of unhealthy foods; lack of knowledge
and skills to plan, shop, prepare and cook healthy foods; lack of motivation to
eat healthily (including risk-taking behaviour). The key enablers found included:
female interest in a healthy diet; healthy diet of friends and family;
support/encouragement of friends and family to eat healthy; desire for improved
health; desire for weight management; desire for improved self-esteem; desire for
attractiveness to potential partners and others; possessing autonomous motiva-
tion to eat healthy and existence and use of self-regulatory skills. This research
provides evidence that can be used to tailor interventions for healthy eating
and overweight and obesity in this population. However, government interven-
tion in addressing food access, affordability, marketing and taxation remains es-
sential to any significant change.

Keywords: Barrier, enabler, nutrition, young adult.

adults in Western countries are gaining weight faster than

Introduction
Contemporary young adults – aged 18 to 24 years – are part
of the first generation to have lived solely in an obesogenic
environment and as a result are found to be ‘becoming
fatter, sooner’ (1). With an average weight gain of 14 kg
over the 15-year duration of young adulthood (2), young
their parents (3) and are more likely to gain weight than
any other age cohort (3). Regardless of initial weight,
weight gain in young adults contributes to adverse changes
in blood lipids, fasting insulin and blood pressure (4). Over-
weight and obese individuals – who account for 38.9% of
the Australian young adult population (5) – exhibit chronic

© 2016 World Obesity Federation Obesity Reviews 18, 1–17, January 2017
2 Barriers and enablers of healthy eating A. E. Munt et al.
disease risk factors and ultimately development of disease
and consequent increase in all-cause mortality at a younger
age (6). Such chronic disease includes metabolic syndrome,
type 2 diabetes mellitus, cardiovascular disease and certain
cancers (e.g. breast) (7). The prevalence of overweight and
obesity in young adulthood has been observed across the
other countries in the developed world including the
United States, New Zealand, Japan and Europe (6,8). This
burden of disease not only affects the welfare and wellbeing
of those overweight and obese but places overwhelming
pressure on the world’s health care system and its resources.
A systematic review found domestic spending of up to $78.5
billion on obesity-related healthcare amongst countries such
as the USA, Canada and China (9). Once established,
weight – and in turn the burden – is hard to lose with a sys-
tematic review finding only 14 of 56 interventions achieving
more than 5% body weight loss and maintenance (10).
The behaviours associated with weight gain – inadequate
intake of wholegrains, fruit and vegetables and excessive
intake of discretionary foods – are synonymous with those
prominent in young adults. Young adults have the highest
consumption of sugar-sweetened beverages (5,11,12) of
any age cohort. They have the poorest intake of vegetables
(5) as evidenced by a significant decrease in intake by more
than half a serve during the five-year transition period after
high school (13). Most alarmingly, only 3.8% of young
adults in a country like Australia meet the ‘2 and 5’ fruit
and vegetable guidelines, respectively (14). Inadequate in-
take of whole grains has also been identified (14). Only half
of young adults were likely to consume breads and cereals
and only 20% of these were wholegrain (14). Young adults
also have the greatest intakes of food prepared outside the
home (15). Around 35% of their energy intake was from
discretionary foods, with alcohol, take-away, convenience
foods and sugar-sweetened beverages of particular note
(14). Young adults have the highest range of binge drinking
(14); calories generally not compensated for that contribute
to weight gain (16). Studies have shown that consumption
of fast food two or more times weekly is associated with
increases in central adiposity in this population (17).
Differentiating the young adulthood life stage from others
is the overwhelming presence of transition and flux. Young
adults face leaving home, beginning tertiary study and/or
employment, changing social groups and potentially norms,
increased autonomy, financial independence, variable resi-
dential and employment stability, potential cohabitation,
increased responsibility for time management, increased
stress, shifting influences and ultimately establishing self-
identity (8,16,18–28). Identity is inextricably linked with
health behaviours as young adults shape their beliefs and
attitudes towards diet and physical activity (16). Confidence
and self-efficacy, crucial in performing and maintaining
healthy behaviours, are also established in this life stage
(16). Perhaps, the most significant aspect of this life stage
Obesity Reviews 18, 1–17, January 2017
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is the opportunity, amidst such change and contemplation
(3), to influence and establish lifelong behaviours (19).
In order to develop an effective intervention, it is impor-
tant to understand the idiosyncrasies of young adults and
ultimately, why healthy dietary behaviours do or do not
occur. This scoping review provides an overview into the
comprehensive and complex factors that contribute to die-
tary behaviours and in turn weight management amongst
young adults. To our knowledge, no other systematic review
on this topic has been conducted. The aim of this scoping re-
view is to (i) synthesize existing qualitative and quantitative
evidence to determine the barriers and enablers of healthy
eating amongst young adults; (ii) provide foundation upon
which much-needed intervention programmes can be devel-
oped and enhanced; and (iii) inform policy and practice to
target the young adult population.
Methods
This review was conducted by following methodology
outlined by Arksey & O’Malley (29), Levac et al. (30),
Colquhoun et al. (31) and The Joanna Briggs Institute (32)
for scoping reviews. It is guided by the primary question:
‘What are the barriers and enablers of achieving healthy
dietary behaviours among young adults?’
Search strategy
Subtopics relating to the key concepts of the question were
identified: young adults, beliefs, lifestyle behaviours, general
barrier/enabler concepts, nutrition, food groups and weight
gain. The research team developed the search strategy with
consultation from the academic liaison librarian. Searches
conducted utilized these subtopics and their associated
mapped subject headings, MeSH terms and keywords to
search databases Medline, Embase, PsychInfo and
CINAHL. An example search strategy from Medline is pre-
sented in Table 1, and remaining search strategies are avail-
able as supplementary files. The following limits were used
on these searches: human subjects only, from 2000 to
current (31 March 2016), population age brackets inclusive
of 18–24 years, peer-reviewed journals and only original ar-
ticles. Reviews were excluded. These inclusion criteria were
decided by the research team to account for suitability of the
scope to the project and maximizing relevance to the
research question. Articles published before 2000 were
unlikely to reflect the lifestyles of the young adults in the cur-
rent environment. Hand searching using similar keywords
was also conducted.
Study selection
All article references found were downloaded to the EndNote
X7 citation management software (Thomson Reuters,
© 2016 World Obesity Federation
obesity reviews Barriers and enablers of healthy eating A. E. Munt et al. 3

Table 1 Search strategy for Medline (Ovid) (date of search: 02/03/16)

# Searches Results

1 Exp body weight changes/ 55,061

2 Body weight/ 168,840
3 Exp obesity/ 157,163
4 Overweight/ 15,079
5 (weight adj3 (manag* or gain or increas* or put on).tw. 73,018
6 1 OR 2 OR 3 OR 4 OR 5 (1–5 OR) 380,085
7 Attitude/ 41,574
8 Exp attitude to health/ 324,977
9 Perception 24,157
10 Body image 14,058
11 Awareness/ 15,809
12 Behaviour/ 27,375
13 Adolescent behaviour 22,866
14 Exp food habits/ 25,920
15 Health behaviour/ 37,932
16 Personal satisfaction 12,940
17 Life style/ 46,440
18 Feeding behaviour/ 41,800
19 Food preferences/ 10,770
20 Motivation/ 53,644
21 Achievement/ 13,813
22 Aspirations/ 795
23 Goals/ 13,015
24 Intention/ 7,324
25 Primary prevention/ 15,213
26 Exp drive/ 9,407
27 ((Behavio?r* or habit* or belief* or believe or perception* or attitude* or aware*) adj5 (health* or diet* 101,784
or nutrition* or eating or food* or lifestyle or life style)).tw.
28 Motivat*.tw. 75,540
29 Enabler*.tw. 901
30 Barrier*.tw. 159,256
31 7–30 OR 889,755
32 Exp diet/ 219,928
33 Exp food/ 1,062,880
34 Exp beverages/ 107,023
35 Sugar-sweetened beverage*.tw. 859
36 Discretionary food*.tw. 13
37 Take-away*.tw. 235
38 (health* adj2 (diet* or eating or food*).tw. 13,948
39 Core adj2 (non- or food*).tw. 556
40 32–29 OR 1,235,013
41 Young adult/ 473,361
42 Adolescent/ 1,701,609
43 Student 40,762
44 (young adj2 (adult* or person* or people)).tw. 81,898
45 18–24.tw. 5,722
46 Adolescen*.tw. 176,219
47 Teenage*.tw. 15,635
48 41–47 OR 1,999,011
49 6 AND 31 AND 40 AND 48 4,728
50 Limit 49 to (English language and humans and year 2000–current and adolescent and young adult 1,300

Philadelphia, PA, USA). One researcher (AEM) then re-
moved duplicates and independently assessed articles by title
and abstract to assess relevance to the research question
(Fig. 1). Full text articles were retrieved and screened by
two researchers (AEM and SRP) independently and then to-
gether to finalize inclusion in the scoping review (Fig. 1). Both
qualitative and quantitative research was included.
Data collection
Data was extracted from included studies by one reviewer
(AEM). Data was extracted to a table and included
author, year of publication, the origin of conduct, aims,
study population and sample size, methodology and key
findings categorized into enablers and barriers (refer to

© 2016 World Obesity Federation Obesity Reviews 18, 1–17, January 2017
4 Barriers and enablers of healthy eating A. E. Munt et al.
Figure 1 Flow chart illustrating the scoping review study selection process.
Supplementary 2). Supporting information from each study
was also recorded. A second reviewer (SRP) then extracted
the data from approximately 20% of the articles, and the
results were compared with the original extraction to check
for completeness and comparability.
Synthesis and analysis of results
Characteristics of the studies including year of publication,
study design, outcomes researched, location, setting and
participant characteristics were tabulated. So too were the
main barriers and enablers identified, along with supporting
data to provide an answer to the research question. A
thematic map was constructed for contextualization and
Obesity Reviews 18, 1–17, January 2017
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completeness of the findings. These tables are accompanied
by a narrative review.
Relevant terminology
For the purpose of this research, an enabler is defined as ‘a
person or thing that makes something possible’ (33) and
a barrier as ‘a circumstance or obstacle that prevents
progress’. (33)
Results
The search strategy (Fig. 1) identified 5,840 citations and
hand searches identified 44 iteratively (Fig. 1). After
© 2016 World Obesity Federation
obesity reviews
removal of duplicates, 5,022 citations were screened based
on title and consequently the abstracts of 251 citations were
examined. After abstract review and exclusion based on
relevance, 69 citations remained for full-text screening.
The 20% of data extracted from included full text articles
by the second reviewer were in agreement, and
consultation with the third reviewer was not required.
Thirty-four studies articles were included. The majority of
studies (15/34) were conducted in the USA (23,34–48),
followed by Australia (8/34) (21,24,27,49–53), England
(4/34) (54–57) and one in Scotland (1/34) (58), Canada (1/
34) (59), Sweden (1/34) (60), The Netherlands (1/34) (42),
Bahrain (1/34) (61), Germany (1/34) (62) and Belgium (1/
34) (63). The studies included were all published after
2005 and distributed throughout the next 10 years from
2006 to 2015. Most of the studies (16/34) were quantitative
(24,36–39,43,45,47,50,55–57,59,61,62,64), 13 of the 34
were qualitative (21,23,27,34,40,44,46,51–53,60,63,65)
and five of the 34 (35,41,42,54,58) were mixed method.
As shown in Table 2, 24 of the 34 studies took place or
used participants from a university and/or college setting,
while only five were conducted within the wider community
(43,52,53,58,60). The average population size was 400
people (range: 25 to 2,942). In nearly all studies (31/34),
the majority of participants were women. Studies used vary-
ing statistical reporting for age of the sample population,
however, as per the search strategy, all included young
adults from the ages of 18–24 years. The majority of studies
(21/34) reported body mass index (BMI) data of the
participants; however, because of variation in reporting
and absence of BMI in the remaining 13 studies, an overall
representation cannot be gained. Most studies referred to
the barriers and enablers of healthy eating in general
whereas some focused more specifically on fruit and vegeta-
ble intake or weight management (Table 2).
Table 3 shows the leading barriers to healthy eating
identified by young adults include: (i) gender-based (male)
apathy towards diet and health; (ii) unhealthy diet of friends
and family; (iii) expected consumption of unhealthy foods in
certain situations; (iv) relative low cost of unhealthy foods;
(v) lack of time to plan, shop, prepare and cook healthy
foods; (vi) lack of facilities to prepare, cook and store
healthy foods; (vii) widespread presence of unhealthy foods;
(viii) lack of knowledge and skills to plan, shop, prepare and
cook healthy foods; (ix) lack of motivation to eat healthily
(including risk-taking behaviour); (x) preferred taste for
unhealthy food; (xi) baseline hunger and lack of satiation;
and (xii) emotional responses that increase appetite and
preference for unhealthy foods.
Table 4 shows the leading enablers of healthy eating
identified by young adults include: (i) gender-based (female)
interest in and implementation of a healthy diet; (ii) healthy
diet of friends and family; (iii) support/encouragement of
friends and family to eat healthy; (iv) desire for improved
© 2016 World Obesity Federation
Barriers and enablers of healthy eating A. E. Munt et al. 5
health; (v) desire for weight management; (vi) desire for im-
proved self-esteem; (vii) desire for attractiveness to potential
partners and others; (viii) possessing autonomous motiva-
tion to eat healthy; (ix) existence and use of self-regulatory
skills; and (x) increased planning, automaticity and habit
of healthy eating.
Discussion
To our knowledge, this is the first scoping review that aimed
to synthesize the research base of barriers and enablers of
healthy eating amongst young adults. There has been mini-
mal research in this population, with only 34 relevant stud-
ies conducted in the past 10 years retrieved. By having a
summation of the literature in this review, health profes-
sionals should be able to review current evidence and in-
form practice, research and policy.
Barriers
The gender discrepancy in interest and motivation towards
health, diet and weight found is supported by the literature;
Wardle et al. (66) revealed – internationally across 23 coun-
tries – that men were less likely than women to follow
healthy eating recommendations. Men were also found to
perceive healthy eating as less important than women, thus
contributing to their behaviour. Fagerli & Wandel further
supported this, finding a higher health consciousness
amongst women (67). This may be explained by historical
social and gender norms. Diet and weight have been tradi-
tionally part of a woman’s domain, fuelled by the patriar-
chal prescription of what it means to be a woman and
their appearance-based worth (68). In contrast, men adopt
machismo and nonchalance towards healthy eating to pro-
mote a masculine identity and disassociate from femininity
(39,69,70). This may mean that young adult men are less re-
ceptive to health promotion than women. It may in part ex-
plain why, in Western countries such as Australia, USA and
UK 69.7%, 70.9% and 66.6% of adult men were over-
weight or obese respectively, compared to 55.7%, 61.7%
and 57.2% of adult women respectively (71–73). To further
engage young men, advocating masculine-driven motivators
such as physique (e.g. the act of ‘bulking’ or ‘shredding’),
the ability to eat more low-calorie foods and sensory appeal
of healthier options could be used (39).
Peer influence on dietary behaviours in this population
was an emerging theme from this review. At a time of meet-
ing new people, morphing social groups and exploration of
identity, young adults appear increasingly susceptible to the
behaviours of others. The social cognitive theory (SCT)
posits that young adults adopt the behaviour of others
through observation and vicariousness and that such behav-
iour becomes ingrained through positive outcomes (74). In
regards to dietary behaviour, observation is multifaceted,
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Table 2 Study and participant characteristics (n = 34)

2
Author Year Origin Design Setting Methods Total population Gender M/F Age (years) (%total sample, BMI (kg/m )) (%total sample,
(% total sample) range, mean (SD) or median) range or mean (±SD))

Poobalan (58) 2014 Scotland Mixed method Community Questionnaire and 1,313 27/71 18/19 years – 35.9% U/weight = 28.9%
focus groups 20–22 – 45.1% Normal = 31.8%
23–25 – 19.0% O/weight = 15.2%
Obese = 6.8%
Giles (54) 2014 England Mixed method University Self-reported diary 50 40/60 19–26 range U/weight = 0%
and community and 1–1 interview Normal = 66%
O/weight = 22%

Obesity Reviews 18, 1–17, January 2017

Obese = 12%
Corsino (34) 2013 USA Qualitative University (multiple) Focus groups 33 24/76 27 (±5.6) 31.6 (±5.1)
Holley (49) 2014 Australia Quantitative University Survey 620 0/100 24 median U/weight = 2.7%
Normal = 53.1%
O/weight = 25.2%
Obese = 19.0%
Jensen (35) 2014 USA Mixed method Adolescent Weight Questionnaire and 40 20/80 15–16 = 20% 24.08 (±3.53)
Control Registry 1–1 interview 17–18 = 42.5%
(AWCR) Participants 19–20 = 37.5%
Kandiah (36) 2006 USA Quantitative University Survey 272 0/100 17–21 years = 83% N/A
Barriers and enablers of healthy eating A. E. Munt et al.

22–26 = 17%
Furia (37) 2009 USA Quantitative University Survey 300 34/66 N/A O/weight or obese = 29%
Other = 71%
Chung (38) 2006 USA Quantitative University Food diary and 236 20/80 N/A N/A
questionnaire
Provencher (59) 2008 Canada Quantitative University Taste rating task, 99 0/100 19.4 (±2.8) 23.2 (±4.2)
questionnaire and
24-h recall
Lake (55) 2009 England Quantitative Middle school > follow- Food diary and 198 41/59 Stage 1 = 11.5 (±0.3) N/A
up in community (same questionnaire Stage 2 = 32.5
population tracked) (±0.33 years)
Barclay (60) 2013 Sweden Qualitative Community 1–1 interview (phone) 2,942 N/A 19 (±N/A) N/A
Levi (39) 2006 USA Quantitative University Questionnaire 358 44/56 18–19 = 74.3 and U/weight = 4.7%
20–24 = 21.5% Normal = 71.8%
25 or older = 4.2% O/weight = 20.1%
Obese = 3.4%
Greaney (40) 2009 USA Qualitative University Focus groups 115 45/55 N/A U/weight = 2.6
Normal = 72.2
Overweight/obese = 25.2
Cluskey (41) 2009 USA Mixed method University Weight tracking 379 60/40 19.03 (±N/A) Females = 22.94 (±4.0)
changes and focus Males = 24.1 (±3.8)
groups
de Bruijin (42) 2009 The Mixed method University Questionnaire and 538 28/72 21.19 (±2.57) N/A
Netherlands focus groups

(Continues)
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© 2016 World Obesity Federation

 Table 2 (Continued)
2
Author Year Origin Design Setting Methods Total population Gender M/F Age (years) (%total sample, BMI (kg/m )) (%total sample,
(% total sample) range, mean (SD) or median) range or mean (±SD))

Kidd (43) 2010 USA Quantitative Community (random Questionnaire 235 36/64 N/A N/A
selection of 18–24
year olds)
Lacaille (44) 2011 USA Qualitative University Focus groups 49 35/65 19.3 (±1.2) Women = 23.3 (±3.3)
Men = 24.5 (±3.7)
Kapinos (45) 2014 USA Quantitative University (housing- Survey (multiple 1,935 45/55 N/A Male = 23.08 (±3.16)
central/female dormitories) over time) Female = 22.50 (±3.47)
Musaiger (61) 2014 Bahrain Quantitative University (multiple) Questionnaire 530 38/62 Men = 21.5 (±3.5) Men = 36.5 (±7.5)
obesity reviews

© 2016 World Obesity Federation

Women = 20.6 (±2.6) Women = 22.9 (±4.9)
Ashton (21) 2015 Australia Qualitative University, TAFE and Focus groups 61 100/0 20.8 (±2.3) 25.3 (±5.1)
community
Hebden (50) 2015 Australia Quantitative University Questionnaire 112 38/62 19–24 range U/weight = 10%
Normal = 72%
O/weight or obese = 18%
Robinson (56) 2015 England Quantitative University Questionnaire 1,056 29/71 21.68 (±4.49) 23.34 (±4.68)
Hattersley (51) 2009 Australia Qualitative University Focus groups 35 34/66 N/A N/A
Pollard (52) 2016 Australia Qualitative Community Focus groups 39 49/51 23.2 (±2.9) N/A
Smith-Jackson (46) 2011 USA Qualitative University (via on 1–1 interview 26 0/100 18.6 (±N/A) 24 (±4.5)
campus housing)
Larson (47) 2012 USA Quantitative Community Survey and FFQ 1,139 42/57 N/A N/A
Robinson (57) 2013 England Quantitative University Food selection 129 35/65 22.4 (±4.5) 22.5 (±3.9)
intervention and
questionnaire
Vaterlaus (23) 2015 USA Qualitative University Focus group and 34 21/79 20.4 (±n/a) U/weight = 3%
1–1 interview Normal = 70%
O/weight = 18%
Obese = 9%
Piggford (24) 2008 Australia Quantitative University Questionnaire 310 40/60 N/A N/A
Harker (62) 2010 Germany Quantitative University Questionnaire 305 36/64 <22 years = 40.3% N/A
Other = 59.7%
Allom (27) 2013 Australia Qualitative University Focus groups 35 29/71 19.46 (±2.31) 21.47 (±5.3)
Dumbrell (53) 2008 Australia Qualitative Community Focus groups 37 overall 25 in 100/0 N/A N/A
18 to 25-year
age group
Nelson (48) 2009 USA Qualitative University Focus groups 50 12/88 19.4 (range 18–21) U/weight = 4%
Normal = 68%
O/weight or obese = 26%
Deliens (63) 2014 Belgium Qualitative University Focus groups 35 40/60 20.6 (±1.7) 22.8 (±3.9)
U/weight = 8.8%
Normal = 61.8%
Overweight or obese = 29.4%

=, equal(s); <, less than; ≤, less than or equal to; >, greater than; ≥, greater than or equal to; %, percent; ±/SD, standard deviation; BMI, body mass index; FFQ, food frequency questionnaire; N/A, not available; O/
weight, overweight; TAFE, technical and further education institutions; USA, United States of America; U/weight, underweight.
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8 Barriers and enablers of healthy eating A. E. Munt et al. obesity reviews

Table 3 Barriers to healthy eating and supporting data

Barriers Supporting data (quoted from articles)

Gender (male)-based It is expected that women care about health, nutrition and body image whereas men have the perception to not care and not
apathy towards diet focus on what they’re eating. This appears to be
and health a marker of masculinity (24).
Major gender differences were observed within this theme, with female participants generally appearing to be more ‘health-
conscious’ than males in relation to beverages. (51)
Females regarded all of these five food motives [including health and weight concern] to be more important than their male
counterparts. (65)
Women, on the other hand, expressed a more specific desire to eat healthy and indicated this was of greater value to them
than did the men. Thus, they seemed more
motivated to eat healthy. (44)
Men, on the other hand, were found to be significantly more influenced by sensory appeal than women (24).
Unhealthy diet of ‘…if your mates suggest a fast food restaurant, if you say “oh let’s get some vegetables”, they’ll laugh at you.’ (53)
friends and family ‘Well my friends that weren’t very health-conscious, they just. tell me that I should just come with them to McDonalds or
something like that…’ (35)
Young adults believing that their peers frequently drank and ate sugar-sweetened soda (SSS) and sweet pastries (SP) were
more likely to consume SSS and SP than young
adults who did not believe their peers frequently drank and ate SSS and SP. (56)
Expected consumption ‘Yeah, ’cause, I don’t know, you feel a little bit less left out if you’re [not] drinking [alcohol].’ (51)
of unhealthy foods in ‘I think depending on like the situation or whatever, quite a lot of like what we would be doing is eating, is more of a social
certain type thing so when we are eating, we’re eating in a
situations group and it’s not like “Hey, come over, let’s all have a salad together” (overweight/obese) (21).
Even though the concern for weight gain is rampant, unhealthy eating at social events is common. Isabella explained the
contradiction: ‘So many girls are trying to lose weight,
but like at our [dorm] parties… they had chocolate night, so that everything was cookies and chocolate and ice cream . . .
I was just thinking, these girls want to lose weight
and yet we’re doing this… I think if there were carrots or healthy things… They wouldn’t come . . . That’s the only way they
would come is if there were sweets there.’ (46)
‘A lot of times, just because it’s time for me to be social…I didn’t even want to go eat last night, but I went with her
[my friend] and I sat down and ate, and I wasn’t hungry.’ (66)
‘And so now we go out and we have to eat more before we go out [so we can] drink more…’ (66)
Relative cheapness of ‘I think cost is a big thing. When you go to the supermarket, you’re thinking, hey, all those vegetables will cost me $10, or I
unhealthy foods could go and get a TV dinner for $3.50…’ (53)
For influences related to healthy eating, 41.2% cited cost (‘not able to buy healthy foods that are inexpensive’) as moderate
and major influences (49).
A couple of the women talked about the higher cost… of fruits and vegetables being a barrier to healthy eating. Madison
said, ‘Vegetables and fruits are a lot
more expensive while Top Ramen is like 19 cents… freshmen don’t have as much money.’ (46)
‘I don’t care what I eat as long as there’s a lot of it and it’s cheap.’ (39)
‘Just a normal sandwich is $5.00 and a small salad is $5.00, but when you compare that to the fried chicken, that’s $2.00
for a pack of eight.’ (66)
Lack of time to plan, For influences relating to healthy eating, 58 · 2% of participants reported not having the time (‘do not have time to prepare or
shop, prepare and eat healthy foods because of my job’). (49)
cook healthy foods 66.5% of male students and 76.8% of female students reported that not having time to prepare or eat healthy foods because
of university commitment was a main barrier to
healthy eating (61).
‘It certainly takes much more time to think about preparing a balanced diet for a week and hitting everything, all the food
groups and a variety of foods and preparing that all and stuff which, I guess if you are busy, you’re not going to prioritize it,
there’s always something else more urgent’ (21)
‘It’s just really hard because it can cost so much and takes so much time and effort to actually live a nutritious lifestyle.’ (41)
Lack of facilities to Likewise, women discussed that the dorms were not well equipped for cooking. Dorms have small refrigerators, and many
prepare, cook and students bring a microwave. Many did not have access to an oven or a freezer, and food storage was an issue (44).
store healthy foods
Widespread presence Participants also felt that unhealthful food served at university cafeterias contributed to overeating and made it difficult to eat
of unhealthy foods healthfully and maintain a healthful weight… Additionally, ready access to un-healthful food, including fast-food restaurants
was seen as making it difficult to maintain a healthful weight (40).
Conversely, lack of access to healthful food, including a lack of grocery stores and transportation to get to them, served as
barriers for weight management for some (40).
Each additional hour of operation of the nearest campus-dining hall was associated with greater weight gain amongst
females (45).

(Continues)

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obesity reviews Barriers and enablers of healthy eating A. E. Munt et al. 9

Table 3 (Continued)

Barriers Supporting data (quoted from articles)

Females living near a grocery store gained half a lb. less than females living further than a ¼ mile from the nearest grocery
store (45).
‘I think everybody overeats, just because you’re in that cafeteria… buffet-style, so everybody is grabbing a lot, and they’re
eating it all, too.’ (66)
Lack of knowledge ‘Sometimes I go to the supermarket as well, and I’m thinking, well, I could add this together with this, and it just turns out a
and skills to plan for, disaster … I end up throwing it in the bin.’ (53)
shop, prepare and 69% of male students and 70% of female students reported that not having skills to plan, shop for, prepare or cook healthy
cook healthy foods foods was a main barrier to healthy eating (61).
Both males and females mentioned that not eating healthful food makes it difficult to maintain a healthful weight; reasons
given were… reliance on precooked meals and unhealthful food, and/or limited knowledge to shop and/or prepare healthful
food (40).
Lack of motivation to ‘I would rather enjoy food than you know be skinny and be healthy. I think you need some fat in your diet and you need
eat healthily (inclusion some excitement from eating as well or you just go off the whole experience.’ (58)
of risk-taking behaviour) ‘I’ve always taken kind of a laissez-faire attitude to, well, foods and activities.’ (54)
‘If you’re in your 20s, you don’t care[about health]. You’re invincible… That’s old persons’ problems.’ (53)
‘We don’t care about our health as much yet maybe when we reach 30 we might start caring more.’ (51)
Teasing and sentiments, such as ‘you only live once,’ were identified as discouraging [healthy eating] (35).
Lack of self-regulation ‘I go through phases of eating healthy then pigging out, sort of thing.’ (58)
behaviours ‘I always have good intentions about…but cake and things always gets me. Pizzas and stuff like that’ (58)
Preferred taste for Taste was the most important influence on food selection in both males and females, with a median (IQR) score of 3.0
unhealthy food (2.0–3.0) reflecting taste to be a ‘very important’ perceived influence (50).
‘I don’t eat diet food. I’m hungry in 30 minutes and it tastes like crap.’ (39)
2
Baseline hunger and …Baseline hunger significantly predicted grams of high calorie snack food [F(1, 122) = 13.1, p < 0.01, ηp = 0.10], whereby
lack of satiation higher scores were associated with greater intake (64).
Emotional responses Under normal conditions, 80% (n = 218) reported they typically made healthy eating choices. When stressed, however, only
(e.g. stress) that 33% (n = 91) of them ate healthy. Regarding
increase appetite comfort food preferences, this study found that individuals who experienced an increased appetite when stressed chose
and preference for significantly more types of sweet foods and mixed
unhealthy foods dishes than those who experienced a decreased appetite or no change in appetite with stress. (36)
‘I know that [being homesick] can cause a lot of stress, and then stressed people overeat.’ (66)

such as what family and friends eat day-to-day and the situ-
ational norm of eating pizza and drinking alcohol before or
at a party. This influence is not limited to face-to-face inter-
action for contemporary young adults, but increasingly via
numerous social media platforms (23). By replicating the
behaviours of those around them young adults gain a sense
of inclusion, acceptance and confidence (74,75). This
suggests that without congruence of healthier behaviours
amongst peers or similar people, health promotion or even
clinical care may be unsuccessful. It also points to the
necessary use of social media platforms, its viral nature,
reach and influence via peer pressure and popularity for
health promotion.
The relative ease of access and availability of un-
healthy diets (defined by time, cost, facilities and pres-
ence of unhealthy food) is a commonly reported barrier
in other populations and is no different for young adults
as found in this review. To balance university, study,
work and social time, our results show that young adults
may perceive contemplation and execution of a healthy
diet as a burden. ‘Time-deepening’ (76) responses may
be employed (such as eating quickly, frequent snacking
as opposed to main meals, ordering takeaway or fast
food and eating while occupied (television, work) (76)
to facilitate a sense of more time. Stress and pressure in
the face of university work; examinations and the tribu-
lations of balancing daily life further contribute to lack
of time (36). These activities contribute to the consump-
tion of energy-dense, nutrient poor foods in excess of
their energy requirements (76). The speed and pressures
of life, especially driven by the technological age, are un-
likely to waver (76,77). Healthier fast food options at
reasonable price points still satisfy time-deepening re-
sponses while offering an opportunity for healthier
young adults; however, further investigation into this is
required.
The convenience of unhealthy foods is another popular
barrier to healthy eating and is in part defined by presence
and proximity of food retailers and the type of food
available. This is a barrier shared by the general population
and was an unsurprising finding. In support of this, the
CARDIA study revealed fast food consumption was most
strongly related to fast food availability close to homes in
low-income individuals (78). In addition, a systematic
review of fast food access revealed that the majority of
studies found higher BMI associated with living in areas with
increased exposure to fast food (79). This was confirmed
again by Michimi & Wimberly (80) finding that the odds

© 2016 World Obesity Federation Obesity Reviews 18, 1–17, January 2017
10 Barriers and enablers of healthy eating A. E. Munt et al. obesity reviews

Table 4 Enablers to healthy eating and supporting data

Enablers Supporting data (quoted from articles)

Gender-based Major gender differences were observed within this theme, with female participants generally appearing to be more ‘health-
(female) interest in conscious’ than males in relation to beverages. (51)
and implementation Females regarded all of these five food motives [including health and weight concern] to be more important than their male
of a healthy diet counterparts. (65)
Women, on the other hand, expressed a more specific desire to eat healthy and indicated this was of greater value to them
than did the men. Thus, they seemed more motivated to eat healthy. (44)
Healthy diet of ‘My parents basically…were the role models for (good) food.’ AND ‘I just think I learned being healthy from my mom growing
friends and family up… we didn’t drink pop… we ate everything really healthy…’ (41)
Also social environment, including peers and family were influential on food choices: ‘Yeah like if your parents are health nuts
whatever then you’ll grow up as wanting that stuff’ (21)
A young adult (female, 21) revealed that social media: ‘ …gives you more ideas to work with. I mean, let’s be honest, we
pretty much all get into our “eating habits” and they may not always be the best or they may be really boring. We eat the
same stuff so sometimes it’s like, “that sounds really good I’m going to try it.” A young adult (male, 21)
stated, ‘I actually use Twitter for good diets and eating habits so [Twitter] is beneficial for me.’ Participants indicated that there
were good opportunities for healthy recipes on social media (23).
‘My mom was like a great cook and she would always do pastas and a lot of mashed potatoes and a lot of starch. I made her
aware that I wanted to lose weight and be more healthy and so she changed things in her meals. She added more greens to
the table and more fruits and we went from drinking crystal light to water, just water.’ (35)
Support/ A higher proportion of 18–24-year-olds reported that they did not have the support of friends to eat a healthy diet compared
encouragement with women aged 25–30 years (37 · 4% vs. 21 · 1%; P < 0 · 001). (49)
of friends and ‘They were a support system.it was a really good thing for our family. We grew closer together. It helped a lot. Each of us was
family to eat able to compare strategies and brag about the goals that we met, and it was great.’ (35)
healthy ‘It’s just nice to hear “Oh, you lost weight.” It’s just really encouraging to know other people notice that.’ (35)
Women identified social support as helpful to eating healthy. (44)
Desire for ‘In response to the first question, “what are some reasons people your age care about their weight?” the three higher- order
improved themes were health…Attributes related to health, participants mentioned energy level, reducing health risk and fewer health
health issues during pregnancy…’ (34)
Respondents who believed the decisional balance pros questions were important consumed more fruit than those who did
not believe the items were important. These included improving health, keeping from getting sick. (38)
The ability to maintain healthy eating behaviour was attributed to the way in which this goal was cognitively framed.
Participants described their healthy eating behaviour as part of an ongoing healthy lifestyle rather than a temporary diet,
improving the likelihood of maintenance… ‘I think it’s a mindset that they need to keep in their minds and integrate it into their
lifestyle not just during the period of time of their diet’ (27)
Most participants mentioned health or medical benefits as a reason for eating healthier foods. This included both short-term
benefits (e.g. general body functioning and immune system) and long-term benefits (e.g. increasing life expectancy). As one
participant said: ‘Well I guess when you eat healthier you…well your body functions better and you
feel better…’ (21)
Desire for weight Health consciousness, weight concern and attitude towards healthy eating are the significant predictors of fruit consumption
2
management (R ) = 0.16). (62)
Respondents who believed the decisional balance pros questions were important consumed more fruit than those who did not
believe the items were important. These included maintaining or losing weight. (43)
‘Just like, well like, its not my first thought (health)… I won’t put on as much weight if I eat lower calorie food’ (58)
Desire for In response to the first question, ‘what are some reasons people your age care about their weight?’ the three higher- order
improved themes were… ‘self’ factors… Attributes related to self factors included self-esteem, confidence, and body image.’ (34)
self-esteem ‘Feel better in myself/lift my mood’ was ranked by 22.3% of participants as most important reason to change weight…Improve
self confidence was ranked by 21.5% of participants as most important reason to change weight. (49)
Desire for ‘I think a lot of people are motivated by aesthetics and looking good with the hope to attract a partner probably’ (21)
attractiveness ‘In response to the first question, “what are some reasons people your age care about their weight?” the three higher- order
to potential themes were… social image…Attributes related to social image included sex appeal, popularity, appearance and good
partners and looks.’ (34)
others Therefore, looking good for the opposite sex served as a major motivator to avoid gaining weight. Isabella said, ‘I think the
main reason [for not wanting to gain the “Freshman 15”] is for guys … As Freshmen girls, you want guys to notice you and
you want to be the center of attention and the one that everybody likes, and you think that would bring you happiness.’ (46)
Possessing The majority of teens emphasized that it was their decision to lose weight and that this decision helped them resist unhealthy
autonomous foods or exercising regularly (n = 38; 95%). (35)
motivation to Both men and women indicated that if students want to eat healthy or be physically active, they can and will do so – ultimately
eat healthy it is up to the individual to make the choice about their behaviour (44).
‘It helped when my parents didn’t pressure—I have to want it in order for it to happen.’ (35)
‘I have to motivate myself . . .’ (41)
Existence and Participants stated that regulating food intake, which was done by ‘eating in moderation,’ ‘watching portion size,’ and not
use of self- exceeding a ‘daily calorie limit,’ (40)
regulatory skills

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obesity reviews Barriers and enablers of healthy eating A. E. Munt et al. 11

Table 4 (Continued)

Enablers Supporting data (quoted from articles)

‘I tried to cut out all the snack food and junk food like that. You can cut if off for a while and then you just end up bingeing. As
of now, I’ll still have ice cream, cake, and brownies. I just have smaller portions of it and only eat it every once and a while.’ (35)
While participants credited their success to their ability to exert self-control, it was consistently noted that this ability was a limited
resource where repeated exertion led to unhealthy eating (Table IV). This reflects previous comments which suggested that at
times participants were more susceptible to environmental cues. However, in order to combat the limited nature of self-control
participants exercised self-control in moderation and allowed a few occasions of unhealthy eating (27).
‘Mental power, definitely…You have to be really committed’ (27)
‘I do think that self-discipline is an important factor (regarding eating behaviour) when you become self-dependent.’ (63)
Increased ‘Like having a plan really helps, so not like you eat whatever you want but know what good things you can eat and where they’re
planning, available’ (27)
automaticity Participants described specific abilities that they regarded as responsible for their success, including planning. It was noted that
and habit of the ability to plan allowed these individuals to better navigate their environment, as unhealthy options did not distract them from
healthy eating their healthy eating goal (67).
Habit strength significantly increased the amount of explained variance in fruit consumption and was the strongest correlate of
fruit consumption in the multivariate analysis. (42)

of obesity increased and odds of consuming fruit and
vegetables decreased as distance to supermarket increase
(metropolitan setting). However, it has also been found that
neighbourhood supermarket availability was unrelated to
adherence to fruit and vegetable recommendations and
overall diet quality (78) and that despite greater availability
of neighbourhood convenience stores, the population still
had lower diet quality (81). These results likely reflect the
interdependence of barriers in promoting unhealthy dietary
behaviours: irrespective of whether a grocery store is nearby,
if the healthy produce remains more scarce or expensive then
young adults will not buy it (82).
Although a widely reported barrier to healthy eating, the
perception of unhealthy diets being cheaper is enhanced by
young adult’s financial instability. A systematic review and
meta-analysis by Rao et al. (83) found that a healthier diet,
or one that is closely aligned to dietary guidelines, is more
expensive by approximately US$1.50/day (whether based
on actual day’s intake or per 2,000 kcal). Similar findings
regarding the relative expensiveness of healthier foods and
diets have been reported in UK, USA and Australian settings
in the literature (84–87). As a result, money-saving practices
are employed. These include purchasing convenience or fast
food that provides a superior ‘bang-for-your-buck’ in
regards to taste, satiety and energy provision. In addition,
purchasing these foods minimizes chance of food and
money wastage. Burns et al. (88) cited a greater likelihood
of purchasing chain-brand fast food on a weekly basis
compared with never when money was scarce. However, it
is important to note conflicting findings in the literature.
This includes Ryden et al. (89) finding that non-energy
adjusted costs were not different for an ordinary diet versus
a Mediterranean diet (89) and Ni Mhurchu & Ogra (90)
finding an insignificant cost difference between a regular
basket of food versus healthy basket. Regardless of whether
the expense of healthy foods and cheapness of unhealthy
foods is accurate in reality, the perception of price strongly
influences preference for unhealthy foods (90).
Young adults have a lack of skills in planning, shopping,
preparation and cooking of healthy foods. Over past
decades, home food consumption and time spent preparing
food have declined significantly (91). A decline of home
economics classes (92), the changing status of women
(91,93) and the increasingly obesogenic environment are
likely responsible for this generational shift whereby such
skills are not role-modelled or taught at home, and there is
limited opportunity to learn them elsewhere (94). Interest-
ingly, such decline plateaued in the mid-1990s, around the
time that current young adults were born (94). Given this
and evidence that food preparation skills have been associ-
ated with decreased fast-food use and better compliance
with dietary guidelines (95), these skills remain important.
However, learning and executing new skills would require
both additional time and costs, adding to their capacity as
barriers. Young adults need to be equipped with skills that
allow them to plan and prepare home meals that are
economical, easy and quick (95) or, at a minimum, select
nutritionally superior pre-prepared/packaged/processed
meals to negotiate time and cost barriers.
Young adults failed to know and comprehend the ef-
fect that nutrition and diet at the current time can have
on health later. Although this was a surprising (albeit
significant) finding, it vindicates the perceived infallibility
and risk-taking behaviour renowned of young adults.
Typically, risk-taking behaviour is associated with illicit
drugs or sexual behaviour (96,97); however, this scoping
review revealed that dietary behaviour – whether con-
sciously or not – could also be an act of risk-taking. In
this scenario, excitement and sensation seeking are
derived from the short-term gain of eating unhealthy
foods (whether that be social inclusion, taste or cheap-
ness) and is deemed more of a priority than long-term
loss or the decline of health. Health professionals need
to consider this cognitive processing of young adults
and perhaps incorporate the principles of drug-
prevention initiatives, too.

© 2016 World Obesity Federation Obesity Reviews 18, 1–17, January 2017
12 Barriers and enablers of healthy eating A. E. Munt et al.
Enablers
Through similar mechanisms, social and situational norms
have the capacity to act as significant enablers. Where
norms foster healthy eating, such as friends eating healthily
or healthy eating trending on social media, it also encour-
ages others to participate to feel included. In contrast to
the gender-driven apathy amongst males, women face
constant pressure to monitor their eating and weight (68).
This can be relied upon to promote engaging with health
promotion and highlights that catering to young adult
women is necessary when designing interventions.
The scoping review revealed having an incentive is an inte-
gral enabler to changing dietary behaviour. Primary incen-
tives include: improved health, weight management and
attractiveness to potential partners (21,34,43,46,49,58,62).
To our knowledge, there is no research determining the
strength and efficacy of these incentives in determining
long-term dietary change. It was surprising to note the citing
of ‘improving health’ as an incentive amongst young adults
given the contrasting state of overweight and obesity
amongst this population. This finding may indicate that
participants reported the ‘right’ or expected answer as part
of health research or it may also be because of the effective-
ness of health promotion and education regarding the
implications of diet, overweight and obesity on health. Alter-
natively, this may reflect that health, as an incentive alone is
not strong enough to promote dietary change.
It was also remarkable to note the popular relationship be-
tween finding romantic partners and weight management in
young adults (21,46). By managing weight and appearance
via diet, young adults feel that they are able to enhance their
social image, popularity and attractiveness and ultimately
success in finding a partner (21,46). Despite the predomi-
nance of overweight and obesity, the thin and fit ideal is still
the default societal standard. Bale & Archer (98) note that ro-
mantic relationships are largely responsible for self-esteem
and that aspiring for attractiveness and desirability is consid-
ered important amongst young adults to finding a relation-
ship. In turn, attractiveness to potential partners ultimately
signifies social acceptance, validating self-worth and improv-
ing self-esteem (98). However, this enabler is inevitably asso-
ciated with upholding an unrealistic standard of beauty, that
self-esteem and value as a person are determined by appear-
ance and acquirement of popularity, desirability and sexual
partners. In turn, self-deprecation, worthlessness, body dissat-
isfaction and a sense of failure are promoted (99). This may
lead to further decline of self-esteem because of the elusive
standards of this incentive (99). Although this scoping reveals
that this is instrumental in encouraging healthy eating, the po-
tential moral, ethical and psychological repercussions of pro-
moting the thin/fit ideal cannot be ignored.
Despite the reporting of barriers, young adults still noted
that healthy eating was ultimately within their power, where
Obesity Reviews 18, 1–17, January 2017
obesity reviews
autonomous or self-driven motivation exists. This is inter-
esting in consideration of the current obesity epidemic. It
needs to be considered whether young adults simply lack
motivation to eat healthy or if they have been conditioned
by the top-down approach that imparts (albeit, an unrealis-
tic) personal burden over changing habits. Regardless, a
meta-analysis by Ng et al. found the self-determination
theory (SDT) to be beneficial in describing the role of
motivation (100). The SDT posits that ‘the type or quality
of a person’s motivation…[is] more important than the total
amount of motivation’ (101). Self-driven motivation is
mostly aligned with autonomous-type-motivation: the
activity is deemed interesting and satisfying and is person-
ally relevant and important (101). In contrast, controlled
motivation involves the expectation of reward or avoid
punishment for the activity and to foster worthiness and
self-esteem and avoid guilt and shame (101). The majority
of literature finds that autonomous motivation promotes
long-term persistence, positive psychological health and
consequently more effective adoption of behaviours than
controlled motivation (101). It could be posited that desire
for appearance and attractiveness are sources of controlled
motivation whereas improved health outcomes are sources
of automatic motivation. The significance of this finding is
an apparent conundrum given the urgency of the young
adult obesity epidemic. Autonomous motivators are likely
to be holistically successful and promote long-term healthy
eating amongst young adults, whereas controlled motiva-
tion may be more appealing, summoning a more immediate
but potentially short-term result.
Amongst successful weight-losers and normal weight
young adults, self-regulation was identified as a key enabler.
One aspect of self-regulation is self-control; ‘the ability to
override or change one’s inner responses, as well as to
interrupt undesired behavioural tendencies and refrain from
acting on them’ (102). In addition, self-efficacy represents
people’s feelings of confidence in their ability to perform
the behaviour in question (102). Having these attributes is
associated with desire to improve health and stronger
intentions (102) and promoting more positive and fewer
negative expectations about the consequences of healthy
eating (103). In comparison, less self-regulation is associ-
ated with stronger belief in the inconvenience and bad taste
of healthier foods (56). What is crucial about self-regulation
is its ability to foster awareness, planning and control over
intake and reduce receptiveness to barriers. Anderson
et al. (103) found that such self-regulatory behaviours had
significant effects on fat, fibre and fruit and vegetable
purchases and intakes and that self-efficacy was the most
important determinant of nutrition behaviour. However,
Giles & Brennan (54) found self-regulation in one area
(whether that be in limiting drinking, increasing physical
activity or improving diet) often came at the expense of
self-regulation in the other area. These findings suggest that
© 2016 World Obesity Federation
obesity reviews
young adults need to be encouraged to make smaller, more
palatable dietary changes instead of an all-or-nothing
approach in addition to strengthening self-regulation skills.
Implications
The barriers and enablers identified can act as the founda-
tion of tailored future health promotion, policy and clinical
care. This scoping review has revealed the multi-faceted
contributors to food choice, encompassing intrapersonal,
interpersonal and wider cultural and socioeconomic factors
(Fig. 2). Traditionally, governments are wary and vigilant in
holding corporations accountable for their role in creating
the obesogenic food environment that contributes to the
low cost, ease and predominance of unhealthy foods. With-
out a significant change in the food environment (such as
subsidy of healthy foods for example), the external barriers
may become too overpowering for the population to over-
come overweight and obesity. Ideally, such a subsidy for
young adults with little income could remedy cost as a bar-
rier. Another policy suggestion might be zoning regulations
for fast food around university campuses as well as placing
regulations on the type of food available on campus and on-
campus living. However, this reach is limited, as it does not
apply to young adults who are not at university nor who
live off-campus. Given governments hesitate to regulate
the food environment, the responsibility to eat healthily
and the blame for failure to do so have been placed on
individuals. Therefore, interventions on an interpersonal
and intrapersonal scale must be maximized. Key areas that
Figure 2 Thematic map. This map contextualizes the origin and existence of barriers and enablers within the wider network of determinants of food
choice and health.
© 2016 World Obesity Federation
Barriers and enablers of healthy eating A. E. Munt et al. 13
need to be focused on are: perceived social norms and peer
influence, skills and knowledge to encourage nutritionally
superior fast and convenient food choices, self-regulatory
skills and the use of relevant incentives to encourage healthy
eating.
Future research based on intervention using these findings
and evaluation of their effectiveness is warranted. This
scoping review allows public health stakeholders to be
aware of and understand the barriers and enablers –
generalizable to this population – and thus begin to test
new interventions.
Strengths and limitations
The strengths of this study include: the synthesis of qualita-
tive and quantitative evidence and thus a unique combina-
tion of statistical and lived-in insight into the experience of
young adults most importantly, definitively name many of
the enablers and barriers of healthy eating relevant to young
adults. The limitations of the current study include: the
possibility that data may not have been captured by the
search strategy (i.e. published findings in journals not
indexed in Medline) and that current research is not exhaus-
tive in terms of themes identified.
Application of results
The majority of these studies were based in Western settings
such as the USA and Australia while the majority of
participants were university students and female. It is also
Obesity Reviews 18, 1–17, January 2017
14 Barriers and enablers of healthy eating A. E. Munt et al.
important to consider the differences between university
settings: USA college culture supports students living on
campus whereas in Australia this is not the case and many
continue to live within the parental home (104). Australian
university students also have the cost deferment HECS-
HELP programme relieving some of their financial
pressures. These differences change the context of themes
such as access, constraints, peer influence and cost. Further-
more, more studies on disadvantaged young adults of lower
educational attainment are indicated. As a result, caution
should be exhibited when generalizing these results to the
wider young adult population. However, this review still
provides an evidence-based insight into the primary and
possible barriers and enablers to healthy eating.
Conclusion
Overweight and obesity amongst young adults is a precar-
ious and intimidating issue. This epidemic is causing signif-
icant health, financial and social ramifications on a local,
national and international level already. Without change,
such outcomes will deteriorate further as these young
adults age and lifestyle disease becomes inevitable. Young
adults present a unique challenge in health promotion –
characterized by flux, transition and exploration – and re-
quire targeted health promotion to adequately support
healthy eating in this population. Engaging family and
friends (particularly via social media), choosing healthier
convenience or fast food options, and promoting health,
weight management and attractiveness to potential part-
ners as incentives could be used to engage this population.
However, there is interdependence between the numerous
determinants of food choice, and it could be postulated
that without addressing all barriers including environment,
the change necessary to remedy this epidemic will not
occur.
Acknowledgements
The authors thank school Librarian Monica Cooper for
his/her assistance with setting up the database search
strategy. This work was supported by the Commonwealth
Government of Australia via an Australian Postgraduate
Award Scholarship to SRP.
Conflicts of interest
MAF currently holds an Australian Research Council
Grant investigating diet in young adults in NSW,
Australia. AEM and SRP report no potential conflicts of
interest.
Obesity Reviews 18, 1–17, January 2017
obesity reviews
Authors’ contributions
AEM, SRP and MAF developed the research question. AEM
drafted the review manuscript and SRP assisted with
screening, extraction and data coding. All authors have read
and contributed to the final manuscript.
Supporting information
Additional Supporting Information may be found in the
online version of this article, http://dx.doi.org/10.1111/
obr.12472
Table S1. Full-text review article selection process
Table S2. Search Strategy for EMBASE (Ovid) (date of
search: 02/03/16)
Table S3. Search Strategy for PsycINFO (Ovid) (date of
search: 02/03/16)
Table S4. Search Strategy for CINAHL (EbscoHost) (date of
search: 02/03/16)
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