Drivers and Barriers of Whole Grain Consumption in the Philippines: 2019 Expanded
National Nutrition Survey
Imelda Angeles-Agdeppa1, Josie Platon-Desnacido1*, Apple Joy D. Ducay1, Charmaine A. Duante1, and Kit Phanvijhitsiri2
1Department of Science and Technology–Food and Nutrition Research Institute, Bicutan, Taguig City, Metro Manila 1631 Philippines
2PepsiCo Services Asia Ltd.,
622 Emporium Tower, 17th and 22nd Floor, Sukhumvit Road, Klongton, Klongtoey, Bangkok 10110 Thailand
Whole grains are considered one of the best sources of dietary fiber, which is beneficial for good health across different population groups. However, consumption remains low in the Philippines.
This study aimed to evaluate the drivers and barriers to the consumption of whole grains among Filipinos across all population groups. The study is part of the dietary component of the 2019 Expanded National Nutrition Survey (ENNS), wherein the master sample (MS) was adopted from the Philippine Statistics Authority (PSA). The ENNS is a two-stage cluster sampling design that covered 39 provinces and highly urbanized cities (HUCs) in the Philippines. About 78% of the 141,167 individuals, aged 3 yr old and above, who were sampled participated in the survey.
Generated data were analyzed using STATA version 15.0. Slightly less than half of the participants (48.4%) consumed whole grains and products. The highest proportion of current consumers was from the highest income quintile (57.1%) and those residing in urban areas (49.6%). The most commonly described consumption pattern was consuming every month (38.7%), and the most common mealtime consumption was during breakfast (43.2%). Among consumers, reported drivers of consumption were as follows: good taste (56.1%), preference or habit of consuming (25.9%), beneficial and good for health (16.0%), convenient to eat, or easy to prepare (11.1%), and attractive packaging (9.7%). Among participants 15 yr old and above, more than half of whole grains were unaware of the health benefits of whole grain consumption, although approximately 20% perceived that the health benefit of whole grains is that they can “make you feel full.” The barriers to consumption were high cost (39.7%), lack of access or availability (36.6%), and bad taste (22.7%). Only half of the Filipinos surveyed were consumers of whole grains and products, and often they are only consuming these once a month. Lack of awareness of its beneficial effects, high cost, inaccessibility, and taste are the barriers to whole grain consumption. In order to increase whole grain consumption, it is suggested that actions to develop simple messages based on the drivers of consumption should be provided across varied communication channels, including social media, to fully address the barriers to whole grain consumption.
Keywords: whole grains, drivers, barriers, consumption, Filipinos
*Corresponding author: [email protected]
ISSN 0031 - 7683
Date Received: 14 Feb 2022
INTRODUCTION
Whole grains have many nutrients and are considered one of the best sources of dietary fiber, essential fatty acids, antioxidant nutrients, vitamins, and minerals – all of which are beneficial across different population groups.
They are among the nutrient-dense plant-based foods that are an important part of a healthy dietary pattern (Jacobs and Tapsell 2015). The health-protective components are found in the germ and bran, which are drastically reduced in refined products (Slavin 2004; Adams and Standridge 2006). Based on widely accepted, existing definitions and new developments, the Definitions Working Group of the global Whole Grain Initiative – with experts from academia, government agencies, and industry – developed definitions for global application. The key statements of the definition documents are as follows: “Whole grains shall consist of the intact, ground, cracked, flaked, or otherwise processed kernel after the removal of inedible parts such as the hull and husk; all anatomical components – including the endosperm, germ, and bran – must be present in the same relative proportions as in the intact kernel” and “A whole-grain food shall contain at least 50% whole-grain ingredients based on dry weight” (van der Kamp et al. 2022).
For several decades, significant evidence stated that consumption of whole grains is associated with lower body mass index, as well as reduced risks of lifestyle- related pathological conditions. The health effects of the intake of whole grain products have been suggested to be protective against a range of chronic diseases – such as type 2 diabetes (Kaline et al. 2007; Ye et al. 2012), heart disease (Mellen et al. 2008), cancer (Schatzkin et al. 2008; Aune et al. 2011), gastro-intestinal health (Marlett et al. 2002). Moreover, whole grains also help to reduce the potential risk factors for non-communicable diseases (NCDs), such as obesity (Cho et al. 2013) and hypertension (Wang et al. 2007; Flint et al. 2009).
Dietary recommendations have often been unclear or inconsistent with regard to the amount of whole grains that should be eaten to reduce the risk of chronic diseases.
In the USA, 48 g are recommended daily (USDA and USDHHS 2010); in Denmark, at least 75 g are advised for a 2,400-kilocalorie diet (Mejborn et al. 2008); three to eight servings are recommended in the Canadian Food Guide (Health Canada 2011); in the United Kingdom and Germany, the food guide simply encourages consuming a variety of grain products (Slavin et al. 2013). In the Philippines, the consumption of whole grains such as brown rice and corn is encouraged and included in one of the dietary guidelines in Pinggang Pinoy (my plate).
The 8th National Nutrition Survey in 2013 revealed that only one in 20 children and adolescents consumed whole grains. Despite the collective evidence of associations
with improved health outcomes, intake of whole grains is relatively low. Shifting people from low or no intake of whole grains to an intake of just one serving (16 g/d, such as 16 g of whole grain wheat, or 30 g product/d, such as 30 g of whole grain wheat bread), based on the Denmark whole grain intake. These small improvements could be largely beneficial for the whole population (Kyro and Tjonneland 2016). This study aimed to evaluate the drivers and barriers to the consumption of whole grains among Filipinos across all population groups.
MATERIALS AND METHODS
Sampling Procedures and Study Design
This study is part of the Dietary Component of the Expanded National Nutrition Survey (ENNS) conducted by the Department of Science and Technology–Food and Nutrition Research Institute (DOST-FNRI). The survey areas for the 2019 ENNS were selected using a methodology called replicated sampling. A replicate is composed of at least five provinces or highly urbanized cities (HUCs). There were a total of 8 replicates in the 2019 ENNS comprising 40 provinces and HUCs.
However, one province (Sulu) was not covered due to unforeseen circumstances.
The ENNS adopted the sampling design of the 2013 master sample (MS) of the Philippine Statistics Authority (PSA). The 2013 MS design for household-based surveys is a two-stage cluster sampling design with barangays/
enumeration areas (EAs) or groups of adjacent small barangays/ EAs as the primary sampling units (PSUs), followed by the selection of secondary sampling units composed of housing units/households. The 2013 MS has 117 sampling domains (81 provinces, 33 HUCs, and three other areas). Sixteen (16) independent sample replicates are drawn from each domain to generate sufficiently precise estimates at the province or city level.
On average, a total of 12 sample housing units/ households are allotted for each sample PSU in a HUC, whereas 16 sample housing units/households are allotted for every PSU in a province domain. Further details on the survey and sampling design of the 2019 ENNS are published elsewhere (DOST-FNRI 2020).
Participants
A total of 141,167 individuals aged 3 yr and above were covered in the study with a response rate of 77.7%.
Individual respondents were grouped into different population groups namely: young children aged 3–5 yr (n
= 11,912), schoolchildren 6–12 yr (n = 30,655), adolescents 13–18 yr (n = 11,685), adults 19–59 yr (n = 63,167), elderly
60 yr and older (n = 17,904), and women of reproductive age (15–45 yr old) disaggregated into three groups: the non-pregnant/non-lactating women (n = 30,039), pregnant women (n = 1,364), and lactating mothers (n = 4,300).
Data Collection
Structured pre-tested questionnaires were administered to determine the frequency of consumption of whole grains, drivers, and barriers to consumption. Participants were asked to describe their consumption of whole grains and products regardless of the kind/types of whole grains consumed. The researchers explained to the respondents the definition and description of whole grains and products and showed sample pictures on the laptops/tablets. For the children aged 3–10 yr, the mothers or caregivers were the respondents. Responses from the participants were collected through the electronic data collection system, a browser-based data collection system developed by the DOST-FNRI (2012).
Data Analyses
Weighted frequency and percentages were constructed to describe the distributional characteristics of the subjects. Proportion estimates were calculated and interval estimates were constructed with a 95% level of confidence. All analyses were performed using STATA Version 15.0. Survey weights were applied in all datasets and calculations to represent national estimates through the complex survey design.
Ethical Considerations
The protocol for the study involving secondary data analysis was reviewed and approved by the FNRI Institutional Ethics Review Committee (FIERC) of the DOST on 31 July 2017, with Protocol Code FIERC-2017-017. It was also reviewed and given technical clearance by the PSA. Consent was obtained in writing from respondents prior to actual data collection.
The informed consent form contained all the components of the survey, detailed data collection procedures, benefits of participation, and non-disclosure of information for anonymity and confidentiality purposes. The contents of the informed consent form are published elsewhere (DOST-FNRI 2020).
RESULTS
A total of 141,167 individuals from 45,957 households participated in the study from the 2019 ENNS (Table 1).
Results showed that nearly half (48.4%) of the population groups were consuming whole grains and whole grain products. Almost a third (31.4%) of the respondents had
stopped consuming, and 20.2% had never consumed any whole grains and whole grain products. Among currently consuming, adolescents (52.0%) had the highest consumption followed by non-pregnant and non-lactating (51.5%) and schoolchildren (49.5%). The elderly (37.8%) had the highest proportion among those who stopped consuming, followed by pregnant women (35.2%) and lactating mothers (33.6%).
On the other hand, young children had the highest proportion (29.7%) among those who never consumed, followed by schoolchildren (22.5%) (Table 1).
A slightly higher proportion of current consumers of whole grains and products was observed in urban areas (49.6%) than in rural areas (47.7%). Higher proportions of those who stopped consuming were noted among respondents in rural areas (33.3%) than in urban areas (28.5%). On the other hand, among those who had never consumed whole grains, the highest proportion was noted in urban areas (21.9%) than in rural areas (19.0%). By wealth quintile, results revealed that the highest proportion of currently consuming whole grains and products was observed among the highest income households (57.1%). Among those who stopped consuming, the highest proportion was reported in the low-income households (33.2%). On the other hand, among participants who had never consumed whole grains, the highest proportion was noted among those households with the lowest income (22.1%) (Table 1).
Frequency of Consuming Whole Grains and Products
More than one-third of the whole grain-consuming population reported consuming whole grains only once a month (38.7%), 36.3% on a weekly basis, and one-fifth (21.9%) consuming on a daily basis. A very small number (3.0%) reported consuming whole grains only quarterly, once a year, or twice a year (Figure 1).
Among age/population groups, the elderly had the highest proportion of consumers of whole grain and products every day at 26.8%, whereas adolescents are reported to have the least whole grain and product consumers at 19.1%. On a weekly basis, adolescents appeared to have the highest proportion of consumers at 41.6%, followed by pregnant women at 40.0% and school-age children at 39.0%, whereas the elderly had the least proportion of consumers at 32.4%.
Adults were reported to have the highest proportion of whole grain consumers at 41.1%, on a monthly basis, followed by lactating mothers at 40.5% and non-pregnant/
non-lactating women at 39.8%. Moreover, young children were observed to have the least proportion of consumers at 35.2%, whereas less than 5% consumed whole grains and products quarterly, once a year, or twice a year across age/
population groups (Figure 1).
Table 1. Percentage distribution of Filipinos by age groups/population groups, sex, wealth quintile, and place of residence by consumption of whole grains and products: Philippines, 2019.
Variable n
No, not ever Yes, consuming Yes, but stop consuming
(%) 95% CI
(%) 95% CI
(%) 95% CI
LL UL LL UL LL UL
Population group
All 141,167 20.2 14.8 26.9 48.4 41.7 55.3 31.4 27.7 35.4
Young children, 3–5 yr 11,912 29.7 24.0 36.1 44.5 37.5 51.7 25.8 22.7 29.2
Schoolchildren, 6–12 yr 30,655 22.5 16.7 29.6 49.5 41.9 57.1 28.0 24.3 32.1
Adolescents, 13–18 yr 11,865 18.3 12.4 26.2 52.0 44.4 59.6 29.7 26.0 33.6
Adults, 19–59 yr 63,167 18.2 13.0 24.9 49.3 42.7 55.9 32.5 28.7 36.6
Elderly, 60 and above 17,904 18.2 13.1 24.7 44.0 37.6 50.5 37.8 34.1 41.7
Pregnant women 1,364 18.9 12.2 28.0 45.9 38.2 53.9 35.2 26.7 44.7
Lactating mothers 4,300 18.4 11.7 27.9 47.9 41.0 54.9 33.6 27.9 39.9
Non-pregnant/ non-lactating
(NP/NL) 30,039 17.0 12.1 23.5 51.5 44.9 58.1 31.4 27.6 35.5
Place of residence
Rural 94,799 19.0 13.2 26.7 47.7 40.3 55.2 33.3 28.9 37.9
Urban 46,368 21.9 16.5 28.5 49.6 43.1 56.1 28.5 25.1 32.2
Wealth quintile
Poorest 35,818 22.1 14.2 32.9 46.2 36.2 56.6 31.6 27.2 36.4
Poor 33,265 20.8 14.3 29.2 46.0 37.8 54.5 33.2 28.7 38.1
Middle 28,997 21.2 15.9 27.7 46.1 39.6 52.7 32.7 28.8 36.9
Rich 23,928 19.5 16.0 23.5 49.4 44.1 54.7 31.1 27.9 34.6
Richest 19,146 15.9 13.5 18.7 57.1 52.9 61.2 26.9 23.0 31.3
Figure 1. Proportion of frequency of consumption among consumers of whole grains and products by age groups/population groups:
Philippines, 2019.
Table 2. Consumption of whole grains and products by mealtime by age groups/population groups, place of residence and wealth quintile:
Philippines, 2019.
Variable Breakfast
(%) AM snack
(%) Lunch
(%) PM snack
(%) Dinner
(%) Late PM snack (%)
Population group
All 43.2 31.7 27.4 37.7 23.8 0.8
Young children, 3–5 yr 43.0 37.8 26.0 38.3 22.4 0.4
Schoolchildren, 6–12 yr 42.1 34.0 25.2 38.0 21.5 0.6
Adolescents, 13–18 yr 43.4 29.7 26.7 36.1 22.6 0.7
Adults, 19–59 yr 42.6 30.4 28.0 38.4 24.5 0.9
Elderly, 60 yr and above 48.9 30.1 31.6 33.5 27.6 1.1
Pregnant women 40.3 32.0 26.7 38.7 20.9 1.4
Lactating mothers 42.4 29.4 27.5 39.2 23.1 1.2
Non-pregnant/ non-lactating
(NP/NL) 43.6 29.5 25.5 37.9 22.6 1.0
Place of residence
Rural 44.6 32.3 30.5 37.2 26.4 0.7
Urban 41.1 30.7 22.9 38.4 19.9 1.0
Wealth quintile
Poorest 50.0 24.9 43.2 33.9 39.0 0.5
Poor 42.7 28.8 33.6 37.6 29.4 0.4
Middle 38.1 33.0 25.3 41.8 21.7 0.9
Rich 37.3 37.0 19.6 41.0 15.5 1.3
Richest 47.9 35.5 12.7 34.1 10.9 1.1
Consumption of Whole Grains by Mealtime
Table 2 showed that almost half of the Filipino population (43.2%) consumed whole grains and products during breakfast. Others prefer it as an afternoon snack (37.7%), whereas only a few consumed whole grains and products as late evening snack (0.8%). The highest percentage consumption of whole grains and products was noted for breakfast and afternoon snacks across all age/ population groups. By place of residence, whole grains and products were mostly consumed in rural and urban areas during breakfast – followed by an afternoon snack, morning snack, lunch, and dinner. By wealth quintile, the lowest and highest income population preferred consuming whole grains and products as part of their breakfast, whereas those belonging to the middle-income population preferred eating whole grains as their afternoon snacks (Table 2).
Reasons for Consuming Whole Grains and Products Results revealed that among the consuming population, more than half (56.1%) reported that the main reason for consuming whole grains and products was due to the good taste – followed by the preference/ habit (25.9%), beneficial to and good for the health (16.0%), convenient to eat/easy to prepare (11.1%), and having an attractive
packaging (9.7%). Less than 1% of those currently consuming gave reasons that they were recommended by doctors/ health professionals, affordable/ cheaper, influenced by advertisement/ social media/ quad media (TV, radio, Facebook, etc.), and others (Table 3). Good taste is the top reason for consumption in all age/population groups: schoolchildren (67.2%), young children (62.2%), adolescents (57.9%), lactating mothers (53.0%), non-pregnant/non-lactating women (52.9%), pregnant women (52.0%), adults (51.6%), and elderly (49.4%). One-fourth of consumers claimed that the second main reason for consuming whole grains and products is preference/ habits. The highest percentage was observed among pregnant women (29.9%) – followed by the elderly (28.9%), adults (27.5%), and lactating women (27.4%).
Beneficial to health was the third reason for consuming whole grains for the elderly (21.5%), non-pregnant/
non-lactating women (20.7%), adults (19.6%), pregnant women (18.9%), lactating mothers (17.3%), adolescents (13.1%), schoolchildren (8.9%), and young children (8.8%). Convenience to eat was another reason for consuming whole grains for the elderly (13.4%), lactating women (12.7%), adults (12.4%), pregnant women (11.8%), adolescents (10.6%), young children (9.1%), and
schoolchildren (7.6%). Finally, the least common reason claimed by all population groups in consuming whole grains and products was influenced by advertisement/
social or quad media (TV, radio, Facebook, etc.) (Table 3).
Perception of Health Benefits of Consuming Whole Grains and Products
The perception of the health benefits of consuming whole grains and products containing whole grains was asked among participants aged 15 yr old and above. Results showed that the majority or six in every 10 (64.7%) adolescents, 15–18 yr old, are unaware or do not know of any health benefits from consuming whole grains and products containing whole grains. These were followed by insights like making one/ you feel full/ can satisfy hunger (15.6%), good source of vitamins and minerals (9.9%), and being rich in complex carbohydrates that can give longer- lasting energy (8.6%). A small proportion of adolescents reported that whole grains and products containing whole grains can prevent or control most NCDs. More than half (55.8%) of the adults, elderly (53.9%), pregnant women
(59.3%), lactating mothers (61.6%), and non-pregnant/
non-lactating (54.4%) are unaware or do not know of any health benefits of consuming whole grains. Other health benefits cited by all population groups are can
“make you feel full”/ can satisfy hunger, rich in complex carbohydrates that can give longer-lasting energy, and a good source of vitamins and minerals (Table 4).
Reasons for Discontinued Consumption
In the Philippines, the top three reasons for discontinued consumption were unavailable, inaccessible, and difficult to find in stores (60.6%) – followed by high cost (26.5%) and got fed up consuming whole grains (14.0%). The following reasons such as rough texture (5.9%); difficult to swallow (5.1%); experiencing adverse/ harmful effects such as bloating, diarrhea, nausea, vomiting, etc.
(2.8%); not being used to eating whole grains (1.6%); and difficulty to prepare (0.8%) were also mentioned by the population group (Figure 2).
Table 3. Reasons for consuming whole grains and products by age groups/population groups: Philippines, 2019.
Reasons All
(%)
Young children, 3–5 yr (%)
School children,
6–12 yr (%)
Adolescents, 13–18 yr
(%)
Adults, 19–59 yr
(%)
Elderly, 60 yr and above (%)
Pregnant
(%) Lactating (%)
WRA, non-pregnant/
non-lactating (NP/NL) (%)
Taste good/ delicious 56.1 62.2 67.2 57.9 51.6 49.4 52.0 53.0 52.9
Preference/ habit 25.9 22.9 21.5 25.8 27.5 28.9 29.9 27.4 25.7
Beneficial to and
good for health 16.0 8.8 8.9 13.1 19.6 21.5 18.9 17.3 20.7
Convenient to eat/
easy to prepare 11.1 9.1 7.6 10.6 12.4 13.4 11.8 12.7 12.8
Attractive packaging 9.7 0.2 0.2 0.3 0.3 0.2 0.3 0.3 0.3
Easily available/ easy
to find at the store 5.1 4.5 4.0 4.6 5.7 5.5 3.3 6.8 4.8
Recommended/
influenced by family members/ relatives/
friends
2.9 4.2 4.2 3.0 2.1 3.0 2.3 2.2 2.2
Recommended by doctor/ health
professionals 0.6 0.2 0.2 0.4 0.7 2.0 0.2 0.4 0.5
Affordable/ cheaper 0.3 7.6 6.5 7.8 11.0 11.3 13.6 13.4 9.5
Influenced by ad- vertisement/ social or quad media (TV, radio, Facebook, etc.)
0.2 0.2 0.2 0.3 0.2 0.4 0.4 0.3 0.3
Others (given by non-relatives or
other people) 0.2 0.2 0.1 0.1 0.3 0.1 0.0 0.1 0.2
Table 4. Perception on the health benefits of consuming whole grains and products among 15 yr old and above: Philippines, 2019.
Benefits of whole grains Adolescents, 15–18 yr
(%)
Adults, 19–59 yr (%)
Elderly, 60 yr and above (%)
Pregnant
(%) Lactating (%)
WRA, non-pregnant/
non-lactating (%)
High in fiber 3.2 5.5 4.5 6.8 4.1 6.6
Help digestion/ prevent constipation 0.8 1.9 2.3 2.3 2.0 2.1
Help lower cholesterol 0.8 3.1 4.1 1.8 2.2 3.2
Help lower blood pressure 0.5 2.5 4.7 2.2 1.4 2.3
Help control weight 1.8 2.1 1.3 2.0 1.0 2.9
Help regulate blood sugar 0.7 4.8 6.6 4.3 3.4 4.4
Good source of vitamins and minerals 9.9 8.1 7.5 10.8 9.6 9.8
May reduce the risk of asthma 0.0 0.1 0.1 0.0 0.0 0.0
May lower the risk of cancer 0.1 0.2 0.2 0.0 0.1 0.3
Rich in complex carbohydrates* 8.6 9.8 8.3 10.4 8.4 10.5
Make you feel full/ can satisfy hunger 15.6 19.6 21.7 16.8 16.5 17.3
Unaware/ do not know of any health
benefits 64.7 55.8 53.9 59.3 61.6 54.4
Others** 0.1 0.2 0.2 0.1 0.1 0.2
*That can give longer-lasting energy
**Chemical-free, no preservatives, food for the kidneys, etc.
Reasons for Not Ever Consuming
Results revealed that among those who had never consumed whole grains and products, the top three reasons were: expensive/cost too much/ not affordable (39.7%), not easily available or accessible/ difficult to find at the store (36.6%) and having a bad taste (22.7%). Conversely, a few proportions of the population expressed that they never consumed whole grains because of the adverse/
harmful effects (bloating, diarrhea, nausea, vomiting, etc.) and were difficult to prepare (Figure 3).
DISCUSSION
This study revealed low consumption of whole grains among Filipinos. Considering the beneficial effects of whole grains on NCDs, obesity, and certain gastrointestinal diseases (Anderson et al. 2009), this merits attention for intervention. In the Philippines, the prevalence of high fasting blood sugar among adults was 8.1%, obesity or overweight was 36.6%, and hypertension was 18.3% – which was tremendously high (DOST-FNRI 2021). In 2013, the prevalence of high total cholesterol (≥ 240 mg/
dL) increased from 4.0% in 1998 to 18.6% in 2013, and for high triglycerides (≥ 200 mg/dL), this also increased from 9.4% in 2003 to 20.5% in 2013 (DOST-FNRI 2016).
Almost half of the consuming population highly considers good taste as an important factor to consider on consuming
whole grains and products, and this is very common in all population groups. Another reason for the continuous consumption of whole grains and products was the personal preference or habit of the individual. In a study conducted in Singapore, it was observed how early exposure to whole grains consumption had a positive impact on the individual’s eating habits and perception of whole grains in the long run (Neo and Brownlee 2017). Aside from early exposure to whole grains, culture can also affect households' food preferences (Ak et al. 2015; Pollard et al. 2017).
Estimated Filipino whole grain consumption patterns vary widely. Only one out of 10 adults or one in 20 children, consumes whole grains, amounting to an average intake of 128.1 g of whole grains per day. Regardless of this data, the national government prioritized whole grain intake (especially, brown rice intake). Similar to Singapore and the United States, the Philippines are public health focused on promoting the consumption of whole grains and products to prevent chronic diseases and improve health and wellness (Toups 2020). Despite half of the population groups consuming whole grains and products, most of the participants do not frequently consume whole grains and products. Most of them consumed whole grains and products on a weekly and monthly basis, whereas only one-fourth of the population groups consumed whole grains every day. This may be related to the affordability, unavailability, and variety of taste of whole grains and products, which will be discussed in the latter part.
Population groups in the highest wealth quintile and those living in the urban areas had a higher proportion of consuming whole grains and products than their counterparts.
These households could purchase any type of food that they like to consume and they do not consider cost a problem.
Furthermore, the population belonging to high-income and urban households was able to sustain the cost of living because urban areas are well-sustained with easily available services or products. The same results have been observed in those related studies conducted in Malaysia, Ireland, and the United Kingdom (Ak et al. 2015). Further, as discussed in the study by Chea and Mobley (2019), the misidentification of whole-grain foods could be one factor for low-income persons' low intake of whole grain diets. Additionally, low- income adults erroneously focused on sensory characteristics such as color and the presence of specific nutrients in foods.
Based on the findings of the study, more than half of the population is unaware of the health benefits of whole grains and products. Identifying the current knowledge on the benefits of whole grains is important since without sufficient knowledge, having positive health behaviors related to adequate intake will be limited (Foster et al.
2020). In a study in Ireland, participants desired more information about whole grains in terms of health benefits and practical assistance in identifying whole grain foods and how to incorporate them into their diet (McMackin et al. 2012).
On the other hand, only one-fifth of the population was aware of the ability of whole grains and products to make one feel full or can satisfy hunger. In a study conducted by McMackin et al. (2012), 50% of participants do not
Figure 2. Reasons to discontinue consumption of whole grains and products: Philippines, 2019.
Figure 3. Reasons for not ever consuming whole grains and products: Philippines, 2019.
know precisely what constitutes whole grains. Moreover, as pointed out by Foster et al. (2020) in their study, participants stated that whole grains were not important in their diet due to a lack of knowledge and unaware of any specific health benefits associated with whole grains. Whole grains are rich sources of dietary fiber and high fiber food promotes satiation (lower meal energy content) and satiety (longer duration between meals) due to its bulk (Raben et al. 1994) and relatively low energy density (Pereira and Ludwig 2001), leading to decreased food and energy intake.
Ignorance of health benefits, inability to identify, lack of preparation knowledge, cost, availability of products in stores, and unacceptable taste and texture were the most common barriers to whole grain consumption sited (Lang and Jebb 2003; Slavin 2004; Kamar et al. 2019). The key to increasing whole grain intake is consumers’ attitudes and perceptions in relation to these products (Kuznesof et al. 2012).
More than half of the population believed that lack of access leads to their discontinued consumption, and less than half said that it caused the people to never consume whole grains and products. Lack of access or availability to whole-grain foods has been cited to be one of the limiting factors to whole grain food consumption among Filipinos – and this is also true in other countries like the United Kingdom, Ireland, Singapore, and Malaysia (Lang and Jebb 2003; Slavin 2004). Countries that had accessible supermarkets with whole grains and products had more consumption compared to countries with less access to supermarkets that offer whole grains and products such as Malaysia (Kamar et al. 2019; Subramanian et al. 2019). Lack of availability may also be correlated to the lack of familiarity with whole grains and products (Chea and Mobley 2019). When the population is only familiar with famous whole grain products, these are the only whole grains they will be searching for in their respective marketplaces. If these are not found, the population then claims that whole grains are not accessible or available. Thus, the increased usage of prominent and clear whole grain labeling on food packaging is essential in identifying all possible product types (Foster et al.
2020). Furthermore, effective nutrition education can be a starting point to increase awareness of whole grain products (Seal and Jones 2007; Chea and Mobley 2019;
Meynier et al. 2020).
In addition to whole grain availability, the Philippines’
production rate of whole grains is not enough to feed its current population and the other sub-sectors that will need it (whole grains as feed for the animal sector) due to the continuous decreasing size of harvesting areas, conversion of lands to non-agricultural land, and nearly monthly devastation on farms caused by typhoon population
(USDA-GAIN 2019). This led the government to actively participate in importing whole grains and products from neighboring countries to support the growing needs of the population.
Cost is the second most common reason for discontinued consumption and not ever consuming whole grains and products – which is similar to the study conducted in Singapore, in which the majority of the participants perceived whole grains and products as high-value products (Neo and Brownlee 2017). The cost was considered a major concern among adults, is less important for adolescents, and is not even mentioned as a concern among children (Meynier et al. 2020). People often prefer to buy the refined counterpart of whole grains since it is cheaper in the market (McMackin et al. 2012).
Interestingly, some of the population consider the bad taste of whole grains and products as a reason for not only consuming but also never consuming whole grains and products. This is also observed in other studies conducted in Singapore (Neo and Brownlee 2017) and Britain (Kamar et al. 2019). Taste is highly subjective and differs from one person to another. In the study by Meynier et al. (2020), the taste of whole grains is the leading barrier for children, whereas it is the third concern among adults.
One must remember that taste provides the experience when eating any type of food and is an important factor in food acceptability (Kuznekof et al. 2012; Jahns 2014).
Whole grain products manufacturing company and product development research team must step up their research and development on future products to improve the taste and suited to their target population group. The key to increasing whole grain intake is consumers’ attitudes and perceptions in relation to these products (Kuznekof et al. 2012).
CONCLUSION AND RECOMMENDATIONS
Only half of the Filipinos surveyed were consumers of whole grains and products but most are only consuming these once a month. The drivers of whole grain consumption are based on satiation provided by the whole grains and so as the taste, preference or habit of consuming, beneficial to and good for the health, convenient to eat and easy to prepare, and attractive packaging. On the other hand, the barriers include lack of awareness of its beneficial effects, high cost, inaccessibility, and the bland taste of the whole grains. Actions targeting the development of simple messages about whole grains must be done widely to increase awareness as well as consumption. Professionals can play a big role in generating awareness, as well as food industries and companies, to educate consumers on whole grains and products containing whole grains through clear
and easy-to-understand messages. Identifying the target population can help create a highly specific approach to increasing whole grain consumption. Further research is also necessary to better understand the barriers to whole grain consumption so that strategies can be designed to encourage increased whole grain consumption.
ACKNOWLEDGMENTS
The authors thank the participants, hired field researchers, and all the hardworking community health and nutrition workers involved in the 2019 ENNS.
FUNDING STATEMENT
This study was funded by PepsiCo Services Asia Ltd.
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