European Journal of Clinical Nutrition (2005) 59, 49–56
& 2005 Nature Publishing Group All rights reserved 0954-3007/05 $30.00
www.nature.com/ejcn
ORIGINAL COMMUNICATION
Changes in diet and physical activity in the 1990s
in a large British sample (1958 birth cohort)
TJ Parsons1*, O Manor2 and C Power1
1
Department of Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK; and 2School of Public Health and
Community Medicine, Hebrew University, Hadassah, Jerusalem, Israel
Objectives: To investigate whether adults studied in 1991 and 1999 (at ages 33 and 42 y) improved their diet and their physical
activity level, in the direction of recommendations issued during the same period.
Design: Longitudinal 1958 British birth cohort study.
Setting: England, Scotland and Wales.
Participants: All births, 3rd–9th March, 1958. A minimum of 11 341 participants provided data at 33 y, 11 361 at 42 y.
Main outcome measures: Frequency of leisure time activity and consumption of (i) fried food, (ii) chips, (iii) wholemeal bread
and (iv) fruit and salad/raw vegetables, at 33 and 42 y.
Results: Most people changed their physical activity and dietary habits over the 8-y period. About a third of men and women
increased, and a third decreased their activity frequency. Findings for fried food consumption were similar. A significantly greater
proportion of cohort members decreased their chips consumption (32%), rather than increased it (17%) and increased their
fruit and salad consumption (30%), rather than decreased it (25%). In all, 26% of men and 33% of women consistently ate, or
switched to eating mostly wholemeal bread, while 56% of men and 48% of women consistently ate less or switched to eating
less. Social gradients were seen for activity and diet in 1991, but associations between social factors or body mass index and
change in activity or diet were inconsistent.
Conclusions: Lifestyle habits such as dietary intake and physical activity are slow to change. Current health promotion strategies
may need to be supplemented with additional methods to affect the desired change in these habits.
Sponsorship: TJ Parsons holds a Medical Research Council Special Training Fellowship in Health Services and Health of the
Public Research.
European Journal of Clinical Nutrition (2005) 59, 49–56. doi:10.1038/sj.ejcn.1602032
Published online 27 July 2004
Keywords: diet; physical activity; cohort study
Introduction
The 1990s was an interesting period in the UK in terms of
health messages relating to diet and physical activity. In
1991, The Committee of Medical Aspects of Food Policy
(COMA) published its report on dietary reference values for
energy and nutrient requirements, and for the first time
there were clear goals for population average intakes
*Correspondence: TJ Parsons, Department of Paediatric Epidemiology
and Biostatistics, Institute of Child Health, 30 Guilford Street, London,
UK.
E-mail: [email protected]
Guarantors: TJ Parsons and C Power.
Contributors: TJP, CP and OM developed the hypotheses for the study,
and participated in writing this paper. TJP and OM did the analyses.
Received 24 November 2003; revised 11 May 2004; accepted 17 June
2004; published online 27 July 2004
(Department of Health, 1991). Specific recommendations
included a reduction in population average total fat intake
(to 35% of food energy intake) and an increase in fibre intake
(from 13 to 18 g/day) (Department of Health, 1991) (these
recommendations existed previously, but in a less specific
form (Department of Health and Social Security, 1984)). The
COMA recommendations enabled the Health of the Nation
document to set a target for fat intake; the proportion of the
population deriving less than 35% of their food energy from
total fat should be at least 50% by 2005 (Department of
Health, 1992). In 1986/87, only 12% of men and 15% of
women derived 35% or less of their energy from fat (The
Dietary and Nutritional Survey of British Adults, 1990). The
recommendations were reinforced by the ‘Balance of Good
Health’ (1994), depicting a plate of different foods, translating dietary recommendations into proportions of food types
Changes in diet and activity in British adults
TJ Parsons et al
50
making up a healthy diet (Food Standards Agency, 2002).
Eight simple food-related guidelines accompanied the food
plate including, for example, ‘don’t eat too many foods that
contain a lot of fat’ and ‘eat plenty of foods rich in starch and
fibre’. In 1994, a COMA report on diet and heart disease
recommended that fruit and vegetable consumption in the
UK should increase by 50%, from an average of three, to at
least five portions per day (Department of Health, 1994). The
‘5-a-day’ message to promote fruit and vegetable consumption, already in use in the US since 1991, was adopted in the
UK, and the ‘Balance of Good Health’ guidelines were
modified to include this message. From 1998, the British
Dietetic Association ran ‘Give me 5’, an educational
campaign on fruit and vegetable consumption. (http://
www.bda.uk.com/faw01.html).
The accepted guidelines for physical activity in the early
1990s were to take part in vigorous activity at least three
times per week, for 20 min or more on each occasion
(American College of Sports Medicine, 1990; Allied Dunbar
Health and Fitness Survey, 1992). In 1995, the government’s
consultation paper ‘More people more active more often’
(Department of Health, 1995) followed new US recommendations (Pate et al, 1995) and encouraged people to take
30 min of moderate activity on a daily basis (at least 5 days of
the week). This activity could be accumulated, for example
in 10 min bouts throughout the day. Between 1996 and
1998, the Health Education Authority ran the ACTIVE for
LIFE campaign to promote the new recommendations, using
among other tools, advertising via the mass media (Hillsdon
et al, 2001).
This study investigates, in a large British population
sample, the extent to which adults changed their physical
activity and dietary patterns over the period 1991–1999
(from age 33 to 42 y), and whether any changes were in the
same direction as the health promotion messages advised.
We looked specifically at whether leisure time activity
increased and, using consumption frequencies of fried food,
chips, wholemeal bread, and fruit and salad combined as
proxies, whether fat intake was reduced, and fibre and fruit
and vegetable intake increased. We also looked at the
characteristics of those who changed their activity or eating
habits in terms of social class, education and body mass
index (BMI).
Participants and methods
Study population
Data are from the 1958 British birth cohort, studied in 1991
(at age 33 y) and 1999 (at 42 y). The original sample included
all children born in England, Scotland and Wales from 3rd–
9th March 1958; surviving children were contacted at ages 7,
11, 16, 23, 33 and 42 y (Butler & Bonham, 1963). The target
samples at 33 and 42 y were 15 600 and 16 460 subjects,
respectively (Introduction to the National Child Development Study (NCDS) 2002). Sample attrition has resulted in a
slight under-representation of those who are most disadvanEuropean Journal of Clinical Nutrition
taged, but the remaining sample is generally representative
of the original sample (Ferri, 1993). We looked at the data
from 42 y; the distribution of social class for those with diet
and activity data of 42 y was very similar to the distribution
for those with social class data at birth.
Measures
Physical activity. In 1991 and 1999, participants were
asked how often they took part in any activity, from most
days to less than twice per month (six categories). The
activity show-card listed: any competitive sports, ‘keep fit’ or
aerobics classes, circuit training, weight training or other
repeated exercises (at home or in the gym) (listed in 1991
only), running or jogging, swimming, cycling, going for
walks, taking part in water sports, outdoor sports, dancing,
any other sport or leisure activity that involves physical
exercise.
Diet. In 1991, participants were asked how often they
ate fresh fruit in summer, salads or raw vegetables in
winter, chips, and fried food, from more than once a day
to never (six categories). In 1999, the questions were
similar except that season was not specified for fruit or
salad/raw vegetables, and food fried in oil and hard fat
were separate questions. Since 90% of men and 95% of
women consumed food fried in hard fat on less than 1 day
per week, we used food fried in oil as our fried food
variable in 1999. In 1991, participants indicated what
sort of bread they usually ate most of, from a list of
eight options, including wholemeal bread and wholemeal
pitta bread, and in 1999, how often they ate (a) wholemeal
bread and (b) other types of bread. We calculated the
proportion of people eating mostly wholemeal bread at both
time-points.
We combined fruit and vegetable consumption to obtain
an indicator of overall fruit and vegetable consumption, and
used fried food and chips as indicators of fat intake. Four
categories were constructed for each variable.
Other measures. Social class was assessed at birth, based
on father’s occupation, according to the UK 1951 General
Registrar’s classification. Four categories are used here:
(i) classes I and II (professional and managerial), (ii) III-NM
(skilled non-manual), (iii) III-M (skilled manual), and (iv)
IV and V (semiskilled and unskilled manual), and those
recorded as having ‘no male head of household’. Qualifications; in 1991 (age 33 y) cohort members were asked to
report qualifications achieved to date. We use five categories:
(i) none, (ii) less than O level, (iii) O levels (were usually
taken at 16 y in school), (iv) A levels (usually taken at 18 y
in school), and (v) higher qualifications (postschool education). BMI (kg/m2) at 33 y was calculated from
height measured to the nearest centimetre and weight
measured with indoor clothing, without shoes, to the
nearest 0.1 kg.
Changes in diet and activity in British adults
TJ Parsons et al
51
Data analysis
All analyses were performed using SPSS for Windows, version
10.0, and carried out for males and females separately. A
Wald-type test (which allows for within-individual dependency) was used to test for a change in distribution of diet or
activity between 1991 and 1999. For further assessment of
the pattern of changes, we used a McNemar test (proportions
of individuals increasing and decreasing their frequency of
activity or diet) and log-linear models (Agresti, 1990). The
extent to which people maintained their frequency level
between time-points was measured by Kappa. Trends in the
likelihood (percentage) of people increasing/decreasing their
activity (or consumption of chips, fried food or fruit and
salad) compared with remaining stable across the (i) social
class, (ii) educational level and (iii) BMI quartile were
assessed using a w2-test.
Results
Physical activity
The distribution of physical activity was similar in 1991 (at
age 33 y) and 1999 (at 42 y) for men and women (Table 1).
Although the cross-sectional distribution suggests little
change over the period, the longitudinal comparison shows
only a modest level of stability, similar for men and women,
with 39 and 37%, respectively, maintaining the same
frequency of activity (Kappa ¼ 0.18 for men, 0.15 for women)
(Table 2). About a third of men and women increased their
frequency and a third decreased it; in men the pattern was
symmetrical where the number changing from activity
frequency i to activity frequency j was similar to that
changing from j to i (Agresti, 1990). Expressing our results
in the context of the current UK recommendations, about
four in 10 men and women either maintained their activity
at four–seven times per week, or demonstrated any increase
in their activity level. Thus, the majority (about six in 10)
either reduced their activity level or maintained it below the
recommendation. About 15% of the sample were inactive at
both time-points.
Diet
The frequency distributions for chips consumption were
significantly different in 1991 and 1999 for both men and
women (Table 1). In all, 50% of men and 52% of women
maintained their consumption frequency (Kappa ¼ 0.23 and
0.24, respectively) while 17% of men and 18% of women
increased their consumption and 33% of men and 30% of
women decreased it (Table 2). For fried food the distributions
in 1991 and 1999 were significantly different in women but
not men, and there was no clear trend (Table 1). In all, 38%
of men and 40% of women maintained their consumption
frequency (Kappa ¼ 0.11 in both genders), and similar
proportions (about 30%) increased and decreased their
consumption (Table 2).
The distributions of fruit/salad/raw vegetable consumption were significantly different in 1991 and 1999, with a
tendency in both sexes towards increasing consumption
(Table 1). Longitudinally, about 45% of men and women
maintained the same consumption frequency (Kappa ¼ 0.23
and 0.21, respectively), while a significantly greater proportion increased (30%) rather than decreased (25%) their
consumption (Table 2). Although 36% of men and 44% of
women either maintained their consumption at more than
once a day or improved it: more than half the study
population maintained an intake of once a day or less, with
four in 10 men and two in 10 women reporting eating fruit/
salad/raw vegetables less than daily on both occasions.
In 1991, 21% of men and 25% of women were eating
mostly wholemeal bread, that increased to 26 and 33%,
Table 1 Leisure activity and dietary habits in 1991 (33 y) and 1999 (41 y)
Leisure activitya
Chips consumptionb
Fried food consumptionb
Fruit and salad consumptionc
1991 (33 y) % 1999 (41 y) % 1991 (33 y) % 1999 (41 y) % 1991 (33 y) % 1999 (41 y) % 1991 (33 y) % 1999 (41 y) %
Males
High frequency
Medium frequency
Low frequency
Rarely
Total n
Females
High frequency
Medium frequency
Low frequency
Rarely
Total n
24
23
21
32
5576
25
22
20
34
5603
19
50
27
4
5581
12
41
44
3
5602
17
39
34
10
5585
19
35
34
12
5596
11
31
45
13
5583
18
30
39
14
5603
28
19
23
31
5765
28
21
17
35
5767
9
42
39
10
5777
6
30
57
8
5768
6
29
45
20
5780
12
26
43
20
5768
25
40
30
5
5781
31
34
28
7
5767
a
High frequency, 4–7 days per week; medium frequency, 2–3 days per week; low frequency, 1 day per week; rarely, r3 per month.
High frequency, Z3 days per week; medium frequency, 1–2 days per week; low frequency, o1 day per week; rarely, never.
High frequency, fruit or salad (or both) 41 per day; medium frequency, fruit or salad (or both) 1 per day; low frequency, fruit and salad 1–6 days per week;
rarely, fruit and salad o1 per week.
All differences in distributions between 1991 and 1999; Pr0.01 except for leisure activity and fried food in men (P40.05).
b
c
European Journal of Clinical Nutrition
Changes in diet and activity in British adults
TJ Parsons et al
52
Table 2 Changes in frequency of leisure activity and diet from 1991 (33 y) to 1999 (41 y)
In 1999 (41 y)
High (%)
Medium (%)
Low (%)
Rarely (%)
N (100%)
Pd
N
42
24
17
16
1148
23
30
24
13
1020
15
22
26
18
945
20
23
33
53
1597
1102
1116
1026
1466
4710
0.05
N
42
26
23
20
1401
19
29
23
15
1057
15
19
21
15
871
25
25
34
49
1730
1357
1004
1174
1524
5059
0.28
N
30
11
3
3
559
45
51
26
17
1960
24
37
66
64
2056
1
2
5
17
140
862
2376
1284
193
4715
o0.001
N
26
6
2
2
270
42
43
18
10
1526
29
47
73
63
2902
4
4
7
25
373
411
2148
2014
498
5071
o0.001
N
31
19
14
11
859
32
42
34
24
1671
26
29
41
41
1603
12
10
12
24
579
750
1854
1656
452
4712
0.55
N
24
14
10
8
577
26
32
26
16
1298
33
41
48
41
2218
18
14
16
35
981
292
1423
2328
1031
5074
o0.001
N
45
25
10
6
840
33
41
26
13
1399
20
29
51
37
1830
2
5
14
45
648
534
1464
2119
600
4717
o0.001
N
55
33
15
5
1606
31
40
31
22
1728
13
24
43
36
1398
2
3
11
37
342
1269
2045
1505
255
5074
o0.001
Frequency of activity/food consumption in 1991 (33 y)
Males
Leisure activitya
High frequency
Medium frequency
Low frequency
Rarely
Females
High frequency
Medium frequency
Low frequency
Rarely
Males
Chips consumptionb
High frequency
Medium frequency
Low frequency
Rarely
Females
High frequency
Medium frequency
Low frequency
Rarely
Males
Fried food consumptionb
High frequency
Medium frequency
Low frequency
Rarely
Females
High frequency
Medium frequency
Low frequency
Rarely
Males
Fruit and salad consumptionc
High frequency
Medium frequency
Low frequency
Rarely
Females
High frequency
Medium frequency
Low frequency
Rarely
a–c
d
see footnotes to Table 1.
P-value for McNemar test comparing the proportion of those increasing and decreasing their frequency.
respectively, in 1999 (data not presented). In all, 26% of men
and 33% of women either consistently ate mostly wholemeal
bread at both time-points or switched to consuming mostly
wholemeal bread, while 56% of men and 48% of women ate
less wholemeal than other types of bread on both occasions,
or switched from eating mostly to less wholemeal bread.
European Journal of Clinical Nutrition
Patterns of activity and diet with social class, education
and BMI
Physical activity and dietary habits in 1991 (33 y) by
education are presented in Table 3. All habits showed some
patterning by education, with greater proportions of the less
educated being inactive and consuming fruit/salad/raw
Changes in diet and activity in British adults
TJ Parsons et al
53
Table 3 Physical activity and dietary habits in 1991 (33 y) by education at 33 y
Education
Higher (%)
A level (%)
O level (%)
oO level (%)
None (%)
Males
Activity; rarely active
b
Chips; low and rare frequency
b
Fried food; low and rare frequency
c
Fruit and salad; low and rare frequency
26
45
56
55
29
31
45
58
34
26
40
59
37
21
35
59
46
21
29
63
Females
Activity; rarely active
b
Chips; low and rare frequency
b
Fried food; low and rare frequency
c
Fruit and salad; low and rare frequency
23
66
76
25
30
58
72
27
31
48
68
35
38
37
57
43
40
27
40
53
a
a
a
Rarely; r3 per month.
Low and rare frequency; o1 day per week.
c
Low and rare frequency; r6 days per week.
b
vegetables infrequently than the more educated, and greater
proportions of the more educated consuming chips and fried
food infrequently (Table 3). The trend for those less educated
to be less active was not evident for the high-frequency
category in men or women (data not presented). Similar
results were observed for social class, except that activity and
fruit/salad/raw vegetable consumption showed no pattern in
men. Relationships were also seen with BMI; those more
active had lower BMIs, most vs least active 25.35 vs 25.81 kg/
m2 (P ¼ 0.001) in men, 24.45 vs 24.88 kg/m2 (P ¼ 0.014) in
women. Women (not men) who ate more chips had higher
BMIs, high vs rare frequency 25.19 vs 24.53 kg/m2 (P ¼ 0.03),
(25.43 vs 25.73 kg/m2, P ¼ 0.30 in men). Similarly women
(not men) who ate more fried food had higher BMIs, high vs
rare frequency 25.52 vs 24.59 kg/m2 (P ¼ 0.003), (25.70 vs
25.76 kg/m2, P ¼ 0.78 in men). Men and women who ate
more fruit and salad had higher BMIs, high vs rare frequency
in men 25.83 vs 25.40 kg/m2 (P ¼ 0.05), in women 24.90 vs
24.13 kg/m2 (P ¼ 0.02).
The proportions of men and women who increased or
decreased their frequency of activity were broadly similar in
terms of social class at birth, educational level at 33 y or BMI
at 33 y (Table 4). The proportions of men and women
increasing their consumption of chips were similar across the
social classes, educational levels and BMI quartiles, but there
was a trend for a greater proportion of those from the lower
social classes and educational levels to decrease their chips
consumption. Among women, the proportion who decreased their chips consumption also increased slightly with
increasing BMI, so that a greater proportion of those with a
higher BMI decreased their consumption (Table 4). Patterns
for fried food showed that greater proportion of those from
higher social and educational BMI groups, and in women,
BMI groups, increased their fried food consumption, while,
as for chips, greater proportions from the lower social/
educational/BMI groups decreased their consumption.
Among men and women who increased their fruit/salad/
raw vegetable consumption, there was little difference by
social/educational/BMI group. Among those who decreased
their fruit/salad/raw vegetable consumption, men of lower
social class and education were more likely to decrease
consumption, as were women of lower education level or
BMI group (Table 4).
Discussion
Within the UK, the 1990s saw major revisions of the physical
activity recommendations—to be physically active on at
least 5 days per week (American College of Sports Medicine,
1990; Department of Health, 1995), reinforcement of the
recommendations to reduce fat and increase fibre intake
(Department of Health and Social Security, 1984; Department of Health, 1991) and new recommendations for fruit
and vegetable consumption—to eat five portions per day
(Department of Health, 1994). Concurrently, greater recognition was given to the potential role of these lifestyle factors
in the prevention of noncommunicable disease (Department
of Health, 1994, 1998) No reference was made to the dietary
or physical activity recommendations in the questions asked
to the 1958 birth cohort members, but this study allows an
insight into national patterns of diet and activity change
over the same period that the recommendations received
widespread attention.
There are certain limitations to our data. We lack
information on occupational physical activity, and on
duration of physical activity, but believe that frequency is a
useful measure in itself, particularly as the current recommendations state that activity can be accumulated throughout the day, and shorter episodes will be more likely to be
forgotten. Although food frequency questions rely on
memory, they allow day-to-day variation to be taken into
account, and do not heavily burden subjects or influence
their eating habits. Information on amounts of food eaten
was not available in our study, but others have found that
most of the variation in food intake is explained by
consumption frequency rather than portion size (Willett,
European Journal of Clinical Nutrition
Changes in diet and activity in British adults
TJ Parsons et al
54
Table 4
BMI
Percentages of those who changed their frequency of physical activity or diet from 1991 (33 y) to 1999 (41 y) by social class, qualifications and
Activity
Decreased
nb ¼ 1377
(m) 1512 (f)
Increased
nb ¼ 733 (m)
845 (f)
Decreased
nb ¼ 1469
(m) 1448 (f)
845
457
2143
930
31
29
29
29
0.84
27
32
34
30
0.01
18
15
17
15
0.55
29
34
33
38
0.007
850
464
2335
1071
32
29
32
31
0.50
32
32
32
33
0.64
22
20
16
17
0.26
21
30
32
35
o0.0001
45
33
32
29
o0.0001
1394
1138
1130
583
358
29
31
28
29
30
0.48
31
33
33
32
26
0.07
18
16
17
14
20
0.33
29
35
35
38
34
0.004
1318
534
1827
820
470
30
34
33
30
26
0.05
33
29
33
31
35
0.25
19
20
16
15
21
0.01
23
26
33
34
37
o0.0001
1155
1179
1159
1147
29
28
31
29
0.44
30
34
30
32
0.24
17
16
18
16
0.28
1185
1184
1196
1177
31
32
32
30
0.71
32
32
32
32
0.95
18
17
18
19
0.25
N 100%
Pd
Females
I and II
III NM
III M
IV and V
Pd
Educatione
Males
Higher
A level
O level
oO level
None
Pd
Females
Higher
A level
O level
oO level
None
Pd
BMIf
Males
1st quartile
2nd quartile
3rd quartile
4th quartile
Pd
Females
1st quartile
2nd quartile
3rd quartile
4th quartile
Pd
Fried food
Increased
nb ¼ 1281
(m) 1472 (f)
a
Social classc
Males
I and II
III NM
III M
IV and V
Chips
33
31
34
36
0.04
26
32
30
34
o0.0001
Increased
nb ¼ 1365
(m) 1590 (f)
Increased
nb ¼ 1349
(m) 1426 (f)
Decreased
nb ¼ 1003
(m) 1206 (f)
33
29
31
29
0.70
19
23
23
27
0.004
17
23
29
32
o0.0001
31
30
30
30
0.99
24
27
25
28
0.23
40
30
29
23
24
o0.0001
21
30
34
39
43
o0.0001
33
34
30
25
27
0.20
18
21
26
31
27
o0.0001
44
39
31
26
23
o0.0001
16
24
29
35
40
o0.0001
31
29
31
28
30
0.62
21
26
26
28
28
0.003
37
35
29
28
0.02
Decreased
nb ¼ 1341
(m) 1276 (f)
Fruit and salad
24
27
32
34
0.02
33
33
31
28
0.25
29
28
29
36
0.01
30
32
30
31
0.80
22
22
24
24
0.29
39
35
32
29
0.001
23
26
30
30
0.12
30
32
29
29
0.27
23
25
25
28
0.03
a
N given for participants with change in activity and social class/education/BMI data. Numbers for change in chips, fried food and fruit/salad consumption varies
slightly (8 to þ 2).
b
N given for participants with change in activity and social class data. Numbers for change in activity and education or BMI varies slightly (16 to þ 91).
c
Social class at birth. Social class V includes those with no male head of household.
d
P-value for w2-test comparing those who increased or decreased their activity/diet with those who remained stable (stable category not shown).
e
Qualifications in 1991 (33 y).
f
BMI in 1991 (33 y). 1st quartile is lowest. Quartile cutoffs, males; 23.1212, 25.1205, 27.5021 kg/m2, females; 21.4421, 23.4501, 26.4453 kg/m2.
1998). We would not claim that our food items encompass
all dimensions of diet but importantly, that they might be
markers for different types of diet. Diets rich in fruit,
vegetables and high fibre foods (eg wholemeal bread) and
lower in fat, sometimes termed a ‘prudent’ or ‘healthconscious’ diet, and also physical activity have been found
to be associated with better self-rated health (Whichelow &
Prevost, 1996; Osler et al, 2001). A low prudent diet score has
European Journal of Clinical Nutrition
been found to independently predict increased mortality
after adjusting for other possible confounders (Osler et al,
2001). Although our study is restricted to a narrow age in
adulthood, this group is an important group to focus on, not
only in terms of their own health but because of their
influence on young children.
We cannot distinguish between time and ageing trends,
but an advantage of longitudinal data is that changes for
Changes in diet and activity in British adults
TJ Parsons et al
55
individuals can be assessed, which may be obscured in crosssectional information. For example, we found the distribution of physical activity for men and women to be very
similar at both time-points, but this hides the fact that twothirds of men and women changed their activity level
between 1991 and 1999, a situation also reported in a
longitudinal study of the ACTIVE for LIFE campaign
(Hillsdon et al, 2001).
In our study, as in others (Health Survey for England,
1999), participation in physical activity was strikingly
low; the recommendation is to participate in moderate
activity on at least five, preferably all days of the week
(Department of Health, 1995), yet at both time-points a
third of the population participated less than once a week.
About 40% of people maintained their activity level at
4–7 days per week or increased their level in this direction,
but importantly, 60% did not. The Allied Dunbar Health
and Fitness Survey identified several barriers to physical
exercise, namely lack of time, needing to relax in spare
time, not being the sporty type and having an injury or
disability (Allied Dunbar Health and Fitness Survey, 1992).
The most common reasons for stopping exercise were
work reasons, loss of interest and needing time to do other
things. These barriers were identified before the change in
recommendations, which shifted from emphasising more
vigorous and sporting activities to moderate and lifestyle
activities, and may or may not be the same today. However,
it is also worth noting that participation in physical activity
tends to decrease with age (Health Survey for England, 1999)
and the fact that we found little change in activity
distribution, particularly in men, could be viewed as
encouraging.
In respect of diet, our study showed a reduction in
consumption frequency of chips, little change in fried food
consumption (although the high-frequency category in
women showed an increase) and some suggestions of
improvement in consumption of fruit/salad/raw vegetables,
and wholemeal bread. Cross-sectional data from the National Food Survey suggest that although during the 1990s,
fruit consumption increased, total fresh vegetable consumption remained almost constant and wholemeal bread consumption declined slightly (Department for Environment,
Food and Rural Affairs, 2001).
It is possible that the increase in fruit and salad consumption is due to wording differences at the two time-points.
Substantially, more salad is eaten in summer (Whichelow,
1993), and therefore the year-round average (1999) would be
expected to be higher than an estimate for winter only
(1991), which we found in our data (not shown). We would
also expect year-round fruit consumption (1999) to be lower
than in summer only (1991). In fact, we saw more people at
the extremes of the distribution at 42 y, that is, consuming
fruit more than once a day or less than once a week (data not
shown). The increase in people consuming fruit less than
once a week may be due to seasonal changes, but the
increase in people consuming fruit more frequently than
once a day is unlikely to be so, and therefore may be
attributed to behaviour change.
We found that in 1991 (at baseline), physical activity
and dietary habits were related to the educational level, and
to a lesser extent, to social class and BMI; similar crosssectional relationships have been found in other studies
(Whichelow & Prevost, 1996; Health Survey for England,
1999; National Diet and Nutrition Survey, 2002). However,
such a relationship between a lifestyle habit and social
class (eg), does not mean that change in that habit will
necessarily be related to social class. For example, we found
that the proportions changing their frequency of physical
activity (either increasing or decreasing), did not vary
by social class, education or BMI group. We did, however,
find relationships for chips and fried food, and the
patterns were unexpected; although similar proportions of
men and women from each social class, education level or
BMI group increased their chips consumption, greater
proportions from the lower social and educational groups,
and in women, higher BMI groups, decreased their consumption. For fried food, the higher social, educational
or BMI groups were more likely to increase consumption
and the lower groups to decrease consumption. These
patterns would act to weaken the cross-sectional associations between chips or fried food and social class or
education over time. In contrast, greater proportions of
men from the lower social classes and men and women from
the lower educational groups decreased their fruit/salad/
raw vegetable consumption, patterns that would act to
strengthen the cross-sectional relationships between fruit/
salad/raw vegetable consumption and social class or education over time.
In summary, we found that most people changed the
frequency of their physical activity level and dietary
intake of fried food, fruit and salad/raw vegetables and
wholemeal bread over an 8-y period suggesting that activity
and dietary habits are amenable to change. However,
between 1991 and 1999, there was no overall improvement
in physical activity or consumption frequency of fried
food, and some improvement in consumption of fruit and
salad/raw vegetables, wholemeal bread, and chips consumption. The changes in consumption of fried food and
chips suggest that those from lower social groups were more
likely to improve their lifestyles; however the changes in
consumption of fruit/salad/raw vegetable consumption
suggest the opposite—that it was those from higher social
groups or with a lower BMI who made positive lifestyle
changes. This suggests that health messages may be taken
up differentially by different social groups, for reasons
that would be worth exploring, but perhaps related to issues
such as food preferences, availability, and cost. For the
population as a whole, it is evident that changes in diet and
physical activity habits in the direction recommended by
health promotion messages is slow, and perhaps additional
strategies will be needed if this rate of progress is to be
increased.
European Journal of Clinical Nutrition
Changes in diet and activity in British adults
TJ Parsons et al
56
Acknowledgements
Data obtained from the UK Data Archive, University of Essex
(files: National Child Development Study, SN 3148, SN
4396). Data providers: Centre for Longitudinal Studies,
Institute of Education and National Birthday Trust Fund,
National Children’s Bureau, City University Social Statistics
Research Unit (original data producers).
References
Agresti A (1990): Categorical Data Analysis. New York: Wiley.
Allied Dunbar Health and Fitness Survey (1992): A report on activity
patterns and fitness levels. London: Sports Council and Health
Education Authority.
American College of Sports Medicine (1990): American College of
Sports Medicine position stand. The recommended quantity and
quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in healthy adults. Med. Sci. Sports Exerc.
22, 265–274.
Butler NR & Bonham DG (1963): Perinatal Mortality. Edinburgh:
Churchill Livingstone.
Department for Environment, Food and Rural Affairs (2001):
National Food Survey 2000. London: The Stationary Office
http://www.defra.gov.uk/esg/Work_htm/publications/cf/nfs/current/
nfs.htm.
Department of Health (1991): Dietary reference values for food
energy and nutrients for the United Kingdom. Report of the Panel
on Dietary Reference Values of the Committee on Medical Aspects
of Food Policy. London: The Stationary Office.
Department of Health (1992): The Health of the Nation: a Strategy for
Health in England. London: The Stationary Office.
Department of Health (1994): Nutritional aspects of cardiovascular
disease. Report of the cardiovascular review group of the
Committee on Medical Aspects of Food Policy. London: The
Stationary Office.
Department of Health (1995): More people more active more often.
Physical Activity in England: A Consultation paper. London: The
Stationary Office.
Department of Health (1998): Nutritional aspects of the development of cancer. Report of the working group on diet and cancer of
the Committee on Medical Aspects of Food and Nutrition Policy.
London: The Stationary Office.
European Journal of Clinical Nutrition
Department of Health and Social Security (1984): Diet and
cardiovascular disease. Committee on Medical Aspects of Food
Policy. Report of the Panel on Diet in Relation to Cardiovascular
Disease. London: The Stationary Office.
Ferri E (1993): Life at 33: the Fifth Follow-up of the National Child
Development Study. London: National Children’s Bureau.
Food Standards Agency (2002): The Balance of Good Health.
http://www.nutrition.org.uk/information/dietandhealth/balanced
diet.html.
Health Survey for England (1999): Cardiovascular disease ‘98.
London: The Stationary Office http://www.doh.gov.uk/public/
hse98.htm.
Hillsdon M, Cavill N, Nanchahal K, Diamond A & White IR (2001):
National level promotion of physical activity: results from
England’s ACTIVE for LIFE campaign. J. Epidemiol.Community
Health 55, 755–761.
Introduction to the National Child Development Study (NCDS)
(2002):
http://www.cls.ioe.ac.uk/Cohort/Ncds/Documentation/
maindocs.htm.
National Diet and Nutrition Survey (2002): Adults aged 19 to 64 years,
Vol 1. London: The Stationary Office. http://www.foodstandards.
gov.uk/science/101717/ndnsdocuments/printedreportpage.
Osler M, Heitmann BL, Hoidrup S, Jorgensen LM & Schroll M (2001):
Food intake patterns, self rated health and mortality in Danish
men and women. A prospective observational study. J. Epidemiol.
Community Health 55, 399–403.
Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C,
Buchner D, Ettinger W, Heath GW, King AC, Kriska A, Leon AS,
Marcus BH, Morris J, Paffenbarger Jr RS, Patrick K, Pollock ML,
Rippe JM, Sallis J & Wilmore JH (1995): Physical activity and
public health. A recommendation from the Centers for Disease
Control and Prevention and the American College of Sports
Medicine. JAMA 273, 402–407.
The Dietary and Nutritional Survey of British Adults (1990): The
Dietary and Nutritional Survey of British Adults. London: HMSO.
Whichelow MJ (1993): Changes in dietary habits. In The Health
and Lifestyle Survey: Seven Years On ed. BD Cox, FA Huppert &
MJ Whichelow, pp 197–220. Aldershot: Dartmouth Publishing
Company.
Whichelow MJ & Prevost AT (1996): Dietary patterns and their
associations with demographic, lifestyle and health variables in a
random sample of British adults. Br. J. Nutr. 76, 17–30.
Willett W (1998): Nutritional Epidemiology. In Modern Epidemiology
ed. KJ Rothman & S Greenland, pp. 623–642. Philadelphia:
Lippincott Williams & Wilkins.